Twin pregnancy complications

Blizanačke trudnoće danas su sve češće. Razlog tomu češće je korištenje metoda medicinski potpomognute oplodnje i starija dob majke. Temeljno načelo u postavljanju dijagnoze blizanačke trudnoće određivanje je korioniciteta. Monokorionske trudnoće rizičnije su od dikorionskih, povezane su s lošijim perinatalnim ishodom i specifičnim komplikacijma poput transfuzijskog sindroma između blizanaca (TTTS – engl. twin-to-twin transfusion syndrome), sindroma anemije i policitemije blizanaca (TAPS – engl. twin anemia-polycythemia sequence) i povratne arterijske perfuzije blizanaca (TRAP – engl. twin reversed arterial perfusion sequence). Hemodinamska neravnoteža između dvaju fetusa nastaje zbog neravnomjerne podjele placente i abnormalnog protoka krvi kroz trasplacentarne anastomoze. Glavne su dijagnostičke metode za otkrivanje navedenih komplikacija ultrazvuk i obojeni dopler (engl. color Doppler). Navedene metode najčešće se nadopunjuju magnetskom rezonancijom i fetalnom ehokardiografijom. Kako bi pravovremeno mogla biti pružena odgovarajuća antenatalna skrb, ključno je što ranije utvrđivanje korioniciteta i intezivno praćenje blizanačke trudnoće, posebice monokorionske. U sklopu antenatalne skrbi postoji nekoliko modaliteta liječenja navedenih stanja: ekspektativne metode sa simptomatskim liječenjem, invazivne metode fetalne terapije i elektivni porođaj. Svaka od njih ima određene prednosti i nedostatke te nisu jasno utvrđene smjernice, već je pristup individualan i ovisi o mnogim čimbenicima. Među invazivnim metodama liječenja ističe se endoskopska laserska koagulacija vaskularnih anastomoza i Solomonove metoda kao zlatni standard u liječenju TTTS-a.Twin pregnancies are becoming more common today, the reason being the overall development of medically assisted fertilization and the older age of the mother. The basis of the twin pregnancy diagnosis is the determination of chorionicity. Monochorionic pregnancies are riskier than the dichorionic ones, as they are associated with a worse perinatal outcome and specific complications such as twin-to-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence (TRAP) and twin anemia-polycythemia sequence (TAPS). The reason for the occurrence of hemodynamic imbalances between two fetuses is the uneven division of the placenta and the existence of abnormal flow through transplacental anastomoses. The main diagnostic methods for detecting these complications are either ultrasound or Color Doppler. They are usually accompanied by magnetic resonance imaging, echocardiography, and flow measurement in the artery of the cerebral media. In order to provide adequate antenatal care in a timely manner, it is crucial to determine the chronicity, and to intensively monitor such pregnancies as soon as possible. Within antenatal care, there are several treatment modalities: expectant methods with symptomatic treatment, invasive methods and elective delivery. Each method has certain disadvantages and advantages. There are no fully established guidelines, so the approach is individual and dependent on many factors. Among the invasive methods of treatment, the endoscopic laser coagulation of vascular anastomoses and the Solomon method stand out as the gold standard in the treatment of TTTS