Course and outcomes of pregnancy in patients with multiple pregnancies with rhesus isoimmunization

Objective. Analysis of the course and outcomes of pregnancy in patients with multiple and rhesus isoimmunization. Materials and methods. 69 pregnant women with multiple pregnancies and Rhesus isoimmunization were examined: 42 (60.9%) patients with relatively favorable obstetric and perinatal outcomes (group 1); 27 (39.1%) with unfavorable outcomes, including early premature birth (28—32 weeks), severe forms of fetal hemolytic disease, fetal hypoxia, lesions of the central nervous system of the newborn, death of the fetus or newborn, two or more replacement blood transfusions (group 2). Results. A high incidence of gestational complications was revealed in groups 1 and 2: iron deficiency anemia in the first trimester (19 and 18.5%, respectively; p>0.05) and in the II—III trimesters (33.3 and 37%; p>0.05), preeclampsia (31 and 29.6%; p>0.05), threats of termination of pregnancy in the first (31 and 40.7%; p>0.05) and II trimesters (26.2 and 33.3%; p>0.05), cervical insufficiency — CI (14.3 and 37%; p=0.04), premature birth (50 and 100%; p<0.00001). In 90.5% of pregnant women with fetal growth retardation, the pregnancy outcomes were relatively favorable (delivery after the 33rd week of pregnancy, mild forms of fetal hemolytic disease, absence of fetal hypoxia and CNS lesions in the newborn). In patients with rhesus isoimmunization and CI, serclage was a risk factor for having children with moderate to severe yellow fetal hemolytic disease (odds ratio 7.20; 95% confidence interval 1.08—47.93; p=0.005). The birth rate of premature babies from triplets (100%) and monochoric diamniotic twins (90%) was higher than that of children from dichoric diamniotic twins (63.6%; p<0.05). In 80% of patients with multiple infertility and severe forms of fetal hemolytic disease, False negative results were obtained with Doppler criterion for the maximum blood flow rate in the middle cerebral artery (MBFR MCA) of fetuses, equal to 1.5 IoM or more, developed by G. Mari et al. for single pregnancy. Conclusion. The outcome of multiple rhesus-conflict pregnancies is influenced by the severity of fetal hemolytic disease, gestational complications, the type of placentation, and the number of fetuses carried. It is necessary to develop gestational normative values MBFR of fetal MCA for multiple pregnancies.