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Antenatal fetal death in multiple pregnancy: is early prediction possible?

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.199

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Abstract

Introduction. Perinatal mortality in multiple pregnancies increases by 8–10 times compared to singletons. Stillbirth is a significant part of all complications of multiple pregnancies. Although the incidence of perinatal mortality in multiple pregnancies has decreased consistently compared to extremely high rates in the past, it remains relatively high, despite significant positive changes in the management of such pregnancies.
Aim: to assess the diagnostic potential of the first trimester's biochemical screening in multiple pregnancies for predicting antenatal fetal death.
Materials and Methods. As part of a retrospective study, a cohort of twin pregnancies after in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or spontaneous conception underwent screening of the first trimester at 11+0–13+6 weeks of gestation as recommended by the Fetal Medicine Foundation. Determination of pregnancy-associated plasma protein-A (PAPP-A) in blood serum with subsequent calculation of the relative PAPP-A MoM (multiples of median) – a multiple of the median (an indicator of how much the individual test result deviates from the reference values) was performed.
Results. Prenatal screening and outcomes of 302 multiple pregnancies showed that with PAPP-A MoM < 0.5, antenatal fetal death occurred with a frequency of 42.86 % (6/14), with PAPP-A MoM within the reference values – In 12.67 % (28/221), with PAPP-A MoM > 2.0 – in 6.7 % (2/30). Differences between patients with PAPP-A MoM < 0.5 and PAPP-A MoM within the reference values, as well as PAPP-A MoM < 0.5 and PAPP-A MoM > 2.0 were statistically significant (p = 0.002 and p = 0.004, respectively). No differences were detected between spontaneous and assisted reproductive technology (ART) pregnancies.
Conclusion. In women with multiple pregnancies resulting from ART or spontaneous, PAPP-A MoM values below the reference interval (< 0.5) in the first trimester are associated with an increased risk of antenatal fetal death.

About the Authors

V. I. Tsibizova
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Valentina I. Tsibizova – MD, Obstetrician-Gynecologist, Research Laboratory of Operative Gynecology, Institute of Perinatology and Pediatrics; Physician, Depart ment of Functional and Ultrasound Diagnostics

2 Akkuratova Str., Saint Petersburg 197341



D. V. Blinov
Institute for Preventive and Social Medicine; Lapino Clinical Hospital, MD Medical Group "Mother and Child"
Russian Federation

Dmitry V. Blinov – MD, PhD, MBA, Head of Medical and Scientific Affairs;

Neurologist

Scopus Author ID: 6701744871. Researcher ID: E-8906-2017. RSCI: 9779-8290

4–10 Sadovaya-Triumfalnaya Str., Moscow 127006;

111, 1-e Uspenskoe Highway, Lapino, Odintsovo District, Moscow region 143081



V. O. Bitsadze
Sechenov University
Russian Federation

Victoria O. Bitsadze – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology

Scopus Author ID: 6506003478. Researcher ID: F-8409-2017

2 bldg. 4, Bolshaya Pirogovskaya Str., Moscow 119991



T. M. Pervunina
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Tatiana М. Pervunina – MD, Dr Sci Med, Director of the Institute of Perinatology and Pediatrics

2 Akkuratova Str., Saint Petersburg 197341



E. V. Komlichenko
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Eduard V. Komlichenko – MD, Dr Sci Med, Deputy Director of the Institute of Perinatology and Pediatrics

Researcher ID: N-5315-2015

2 Akkuratova Str., Saint Petersburg 197341



I. E. Govorov
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Igor E. Govorov – MD, PhD, Doctor of Philosophy in Medicine, Obstetrician-Gynecologist, Head of the Research Laboratory of Operative Gynecology, Institute of Perinatology and Pediatrics

Scopus Author ID: 57188586021. Researcher ID: P-1257-2015

2 Akkuratova Str., Saint Petersburg 197341



E. K. Kudryashova
Leningrad Regional Clinical Hospital
Russian Federation

Elena K. Kudryashova – Head of the Department of Medical Genetic Counseling

45–49 Lunacharsky Ave., Saint Petersburg 194291



I. I. Averkin
Almazov National Medical Research Centre, Health Ministry of Russian Federation
Russian Federation

Igor I. Averkin – Pediatric Cardiologist, Department of Pediatric Cardiology

2 Akkuratova Str., Saint Petersburg 197341



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For citation:


Tsibizova V.I., Blinov D.V., Bitsadze V.O., Pervunina T.M., Komlichenko E.V., Govorov I.E., Kudryashova E.K., Averkin I.I. Antenatal fetal death in multiple pregnancy: is early prediction possible? Obstetrics, Gynecology and Reproduction. 2020;14(6):602-611. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.199

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