Многоплодная беременность остается одним из наиболее значимых факторов риска преждевременных родов (ПР), являющихся ведущей причиной перинатальной заболеваемости и смертности. В настоящей статье представлен анализ современного состояния проблемы ПР при многоплодной беременности. Рассмотрены эпидемиологические аспекты, основные факторы риска (ятрогенные, спонтанные), особенности патофизиологических механизмов, отличающие многоплодие от одноплодной беременности. Особое внимание уделено современным стратегиям прогнозирования ПР (оценка длины шейки матки, биохимические маркеры), а также подходам к профилактике, включая эффективность назначения прогестерона, серкляжа, пессариев и токолитической терапии. Обсуждаются актуальные вопросы тактики ведения беременности, направленной на пролонгирование гестации и улучшение перинатальных исходов. Подчеркивается необходимость дальнейших исследований для оптимизации профилактических и лечебных мероприятий в этой высокорисковой группе пациенток.
Multiple pregnancies remain one of the most significant risk factors for premature birth, which is the leading cause of perinatal morbidity and mortality. This article presents an analysis of the current state of the PR problem in multiple pregnancies. The epidemiological aspects, the main risk factors (iatrogenic, spontaneous), and the features of pathophysiological mechanisms that distinguish multiple and single pregnancies are considered. Special attention is paid to modern strategies for predicting pregnancy (assessment of cervical length, biochemical markers), as well as approaches to prevention, including the effectiveness of prescribing progesterone, cerclage, pessaries and tocolytic therapy. Topical issues of pregnancy management tactics aimed at prolonging gestation and improving perinatal outcomes are discussed. The need for further research is emphasized to optimize preventive and curative measures in this high-risk group of patients.
Multiple pregnancies remain one of the most significant risk factors for premature birth, which is the leading cause of perinatal morbidity and mortality. This article presents an analysis of the current state of the PR problem in multiple pregnancies. The epidemiological aspects, the main risk factors (iatrogenic, spontaneous), and the features of pathophysiological mechanisms that distinguish multiple and single pregnancies are considered. Special attention is paid to modern strategies for predicting pregnancy (assessment of cervical length, biochemical markers), as well as approaches to prevention, including the effectiveness of prescribing progesterone, cerclage, pessaries and tocolytic therapy. Topical issues of pregnancy management tactics aimed at prolonging gestation and improving perinatal outcomes are discussed. The need for further research is emphasized to optimize preventive and curative measures in this high-risk group of patients.