Učestalost, komplikacije i ishod višeplodnih trudnoća

master's thesis

• Title (english): Prevalence, complications and outcomes of multiple pregnancies
• Author: Valentina Marinović
• Mentor: Emilja Juretić (mentor)
• Committee member: Vesna Elveđi Gašparović (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Emilja Juretić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2017-09-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Učestalost je višeplodnih trudnoća u porastu u cijelome svijetu. S jedne strane, uzrok tomu je starija dob trudnica, a s druge strane, veća učestalost primjene postupaka medicinski pomognute oplodnje kao što su indukcija ovulacije i in vitro fertilizacija. Dok je kvaliteta neonatalne skrbi znatno napredovala u posljednjih nekoliko desetaka godina, višeplodne trudnoće i dalje nose znatno veći rizik za nepovoljan ishod u odnosu na jednoplodne trudnoće, i za majku i za dijete. Novorođenčad iz takvih trudnoća ima znatno viši morbiditet i mortalitet. Ona se češće rađaju prijevremeno i niske rodne mase, u njih je češće intrauterino zaostajenje u rastu, neonatalne komplikacije, kongenitalne anomalije i neurološka oštećenja. Kod majki je u trudnoći češći razvoj komplikacija kao što su preeklampsija, gestacijski dijabetes i hipertenzija. Ishod višeplodnih trudnoća u velikoj mjeri ovisi o stanju posteljice, odnosno o korioničnosti i zigotnosti. Monokorionske trudnoće imaju češće komplikacije zbog vaskularnih anastomoza između krvnih optoka fetusa. Zbog toga je moguć razvoj specifičnih patoloških stanja, kao što je sindrom blizanačke transfuzije. Stoga je ključno određivanje korioničnosti što se najbolje postiže ranim ultrazvučnim pregledima. Jedna od važnih strategija danas u svijetu prevencija je nastanka višeplodne trudnoće usavršavanjem tehnika indukcije ovulacije i transferom manjeg broja embrija pri in vitro fertilizaciji. Nakon začeća, premda etički dvojbeno, moguća je redukcija broja fetusa.

Abstract (english)

The incidence of multiple pregnancies is increasing worldwide. The cause for this is childbearing at older age, as well as increasing use of fertility therapies and assisted reproductive technologies. Although, the quality of neonatal care improved over the last decades, multiple pregnancies are still associated with increased risk of adverse outcomes, both for the mother and the infant. Mortality and morbidity rates of infants are higher in multiple pregnancies. Rates of premature labor, low birth weight, growth restriction, neonatal complications, congenital anomalies and neurodevelopmental delay are much higher. Complications affecting the mother are preeclampsia, gestational diabetes and hypertension. Outcome of multiple pregnancies is predicted mostly by chorionicity and zygosity. Monochorionic pregnancies have a higher risk of adverse outcomes, mostly due to specific vascular anastomosis that connect the two fetal circulations. The result of that is the occurrence of specific pathological conditions, such as twin-to-twin transfusion syndrome. Therefore, the assessment of chorionicity is crucial, which is best determined by early ultrasound. It is very important to prevent multiple pregnancies, which is done by improving fertility treatment techniques and transferring less embryos during in vitro fertilization. It is also possible to reduce the number of fetuses after conception, which raises a lot of ethical concerns.

• Keywords: novorođenče; višeplodna trudnoća; korioničnost; zigotnost
• Keywords (english): infants; multiple pregnancy; chorionicity; zygosity
• Language: croatian
• URN:NBN: urn:nbn:hr:105:573558
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-10-27 09:30:52