Ukrainian Journal «Health of Woman»

Results of the clinical and molecular-histological assessment of the effectiveness of the drug PROTEFLAZID® in the treatment of papilomavirus infection in women with cervical intraepithelial neoplasia

V.O. Potapov — 2024-10-25

Aim — to evaluate the clinical and molecular-morphological effectiveness of the drug PROTEFLAZID® when used in the treatment of human papilloma virus (HPV) infection in women with a cytological koilocytic reaction, as well as in cervical epithelium combined with a mild degree of cervical intraepithelial neoplasia (CIN).

Materials and methods. Based on the results of the Pap test and HPV test, 90 women aged 20 to 35 years were involved in the study, who were divided into 3 groups: the group I (control) — 30 women with a negative HPV test and no CIN, the group II — 30 women with a positive HPV test without CIN, the group III — 30 women with CIN I on the background of HPV infection.

The article presents the results of a clinical and molecular-histological assessment of the effectiveness of the simultaneous use of oral and vaginal forms of the drug PROTEFLAZID® in the treatment of cervical HPV infection in women, which contributed to the eradication of HPV in 76.7–86.7% of cases, and in combined HPV-infections with cervical intraepithelial neoplasia of a mild degree (CIN I) — in 76.7% of patients until its persistent regression, which was due not only to the antiviral effect of PROTEFLAZID®, but also to its effect, as shown by the results of an immunohistochemical study, on the reduction of the expression of nuclear proteins p16 and Ki-67, which are reverse regulators of the cell cycle and significantly increase when cervical epithelial cells are affected by HPV.

Conclusions. The drug PROTEFLAZID® is currently one of the most effective drugs for the treatment of HPV infection, which can be recommended for the eradication of papillomaviruses in women with both low-risk cervical intraepithelial neoplasia (CIN I) and positive HPV-tests with a normal Pap test.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the author.

Women of reproductive age endogenous intoxication level assessment after surgical treatment of endometriosis

O.A. Dyndar — 2024-10-25

Endometriosis develops and progresses under conditions of initial endogenous intoxication (EI) and negative changes in the body's reactivity. Surgical treatment is accompanied by tissue destruction at the site of trauma, aseptic inflammation, pathological protein catabolism, and massive cell death, which may lead to the development of a syndrome of mutual aggravation.

Aim - to determine the level of EI in women of reproductive age with endometriomas, depending on the surgical treatment method.

Materials and methods. A laparoscopic surgical treatment was performed on 120 reproductive-aged patients with ovarian endometriomas. The Group I consisted of 60 women who underwent bipolar coagulation (BPC) of the ovarian medullary layer, while the Group II included 60 women who received BPC of both the medullary and cortical layers. The EI level was assessed postoperatively based on the clinical course during the postoperative period, general blood test indicators, and biochemical markers of tissue destruction products (TDP).

Results. In the postoperative period, patients in the Group I showed lower levels of TDP such as medium-mass molecules (MMM₂₈₀, MMM₂₅₄), acid-soluble fractions of nucleic acids (ASFNA), malondialdehydes of thiobarbituric acid (TBA), and a 2.2 times higher endotoxic index (ETI) than women in the Group II.

Conclusions. After laparoscopic surgery with BPC of the ovarian medullary layer, the EI level showed less significant manifestations, as confirmed by a 1.3-fold decrease in MMM₂₈₀, MMM₂₅₄, and ASFNA levels, a 1.2-fold decrease in TBA levels, and a 2.2-fold increase in ETI levels. The most sensitive and early markers of tissue destruction in reproductive-aged women with endometriomas after laparoscopic surgery with BPC are ASFNA and TBA. Among patients who underwent laparoscopic surgery with BPC of the medullary layer, leukocytosis was 1.3 times less common, the number of patients with elevated C-reactive protein levels was 1.2 times lower, and the rehabilitation period was reduced by 1.2 times compared to patients who received BPC of both the medullary and cortical layers of the ovary.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all patients.

The authors declare no conflict of interest.

Diagnostic sensitivity and specificity complex in women with intraepithelial lesions of the cervix utery

Kh.V. Zarichanska — 2024-10-25

Aim - study the molecular and biological features of cervical intraepithelial lesions (SIL) using the immunocytochemical method of determining the oncoprotein p16ink4α and the proliferation marker Ki67 in order to further develop a highly effective method for the early diagnosis cervical cancer.

Materials and methods. Examined 150 women with a histologically verified diagnosis of SIL, of which the group 1 - 74 women with low-grade squamous intraepithelial lesion of the uterine cervix (LSIL) and the group 2 - 76 women with high-grade squamous intraepithelial lesion of the uterine cervix (HSIL). The control group included 70 women without morphological changes negative for cervical intraepithelial lesion (NILM). The average age of the patients is 32.7±0.5 years. Liquid cytology was taken from all patients and an immunocytochemical method (ICH) was performed to determine the expression of the oncoprotein p16ink4α and the proliferation marker Ki67 and complex genotyping of HPV DNA of 28 types. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistical 6.0 programs.

Results. The expression of the oncoprotein p16ink4α in patients of the group 1 (LSIL) was 27.2% of atypical squamous cells in the smear, the proliferation marker Ki67 was 11.6%. In women of the group 2 (HSIL), expression of oncoprotein p16ink4α - 58.9%, proliferation marker Ki67 - 30.7%. In patients of the control group (NILM), individual p16ink4α - positive cells were found in 0.72%, while they lacked the expression of the proliferation marker Ki67, which allowed to classify them as "senescent" cells. For p16ink4α, diagnostic sensitivity was 97.4%, diagnostic specificity was 76.8%. For the proliferation marker Ki67, diagnostic sensitivity was 100%, diagnostic specificity was 92.8%.

Conclusions. The most informative method for detecting SIL is p16ink4α/Ki67 coexpression: diagnostic sensitivity - 98.5%, specificity - 100% compared to liquid cytology and HPV test.

The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. A informed sonsennt was collected in order to carry out the research.

The author is stating no conflict of interests is declared.

Tocolytic therapy safeness in various gestational terms

S.S. Leush — 2024-10-25

Hexoprenaline and nifedipine, known for their side effects, are currently most often used for tocolysis. Duration of use and interactions with other drugs require further study.

Aim was to compare the clinical and laboratory manifestations and consequences of tocolysis with hexporenaline and nifedipine in neonates and mothers.

Materials and methods. The results of tocolysis with hexoprenaline and nifedipine for more or less than 48 hours before delivery time were compared in extremely premature terms of labor (EPP group - 22-27 weeks, 77 parturients) and in terms of moderate premature parturition (MPP group - 28-34 weeks, 73 parturients).

Results. 80.0% and 90.9% of newborns survived within a week in the EPP and MPP groups after tocolysis with hexoprenaline for more than 48 hours. After tocolysis with nifedipine - respectively 66.7% and 92.9%, survival after hexoprenaline is 80.0%, nifedipine is 66.7% in the EPP group. Survival after prolonged tocolysis is higher than the average for the group (63.6%), in the MPP group the difference was 90.9 and 92.9%, without tocolysis 90.0%, and the average for the group was 90.4%. Survival in the EPP group with short-term tocolysis with hexoprenaline (50.0%) and nifedipine (60.0%), close to that without tocolysis (55.2%) and less than the average the EPP group (63.6%). All newborns survived after nifedipine, after hexoprenaline 81.8%, without tocolysis 90.0% in the MPP group. Moderate hyperglycaemia (5.6±0.58 mmol/L and 5.3±0.69 mmol/L) was observed after hexaprenaline and nifedipine, 4.2±0.37 mmol/L without tocolysis.

Conclusions. The lower survival rate of extremely preterm infants does not depend on the tocolysis type or its absence and is associated with immaturity in accordance with the term, and not with effectivelessness of therapeutic influences. Survival of moderately preterm infants after tocolysis with nifedipine showed a better outcome. A side effect of tocolysis with both drugs studied was an excess up to 30% of the mean glycemic value. It is desirable to give preference to hexoprenaline at 22-27 weeks, and tocolysis with nifedipine is more appropriate for MPP (28-34 weeks term).

The study was carried out in accordance with the Helsinki Declaration principles. The study protocol was adopted by the Local Ethics Committee of the Bohomolets NMU. Informed consent from the women for the study was obtained.

Authors declare no conflict of interest.

Urinary infections and perinatal losses

V.O. Beniuk — 2024-10-25

Today, one of the leading factors contributing to perinatal losses are infections, especially of the urogenital tract.

Aim - to assess the presence of infection, especially of the urogenital tract, in women with perinatal losses and establish their role in the genesis of stillbirth.

Materials and methods. A prospective examination of 45 patients with miscarriage after 12 weeks was conducted - the main group, divided into the subgroup I (n=24) - women with miscarriage in the period from 12 to 21 weeks 6 days; the subgroup II (n=21) – women with antenatal fetal death. The control group - 30 patients with advanced pregnancy. We determined the microbiocenosis of vaginal secretions, the group B streptococcus. The reliability of the research results was assessed using Student's and Fisher's criteria. A statistically significant difference was considered at p<0.05.

Results. The average age of pregnant women in the main group was 26±2.1 years. Every third patient of the main group had a history of otorhinolaryngology pathology. Pathology of the urinary system was noted by 44.4% of patients in the main group. The course of this pregnancy was complicated by nausea and vomiting of pregnancy, threat of abortion, asymptomatic bacteriuria; polyhydramnios. Pathological degrees of microbiocenosis in the main group were diagnosed twice as often as in the control group (p<0.05). Gram-positive microflora prevailed. The concentration of Lactobacillus spp. in the main group was 4.2±1.8 CFU/ml. The growth of the group B streptococcus in vaginal secretions in the main group occurred 3.5 times more often than in the control group.

Conclusions. Among women with miscarriage after 12 weeks, an important role of infection of the urogenital tract (Ureaplasma urealyticum, Gardnerella vaginalis, Streptococcus spp.) has been assigned, which has a direct impact on the course of pregnancy. Somatic pathology was also noted in the examined women: inflammatory diseases of the genital organs (37.8%), gestational pyelonephritis (28.6%), threatened miscarriage (29.2%); polyhydramnios (20.9%). An association of opportunistic vaginal microflora at a concentration of 106 CFU/ml and a decrease in Lactobacillus spp.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was adopted by the Local Moral Committee of the institution indicated in the work. Informed consent was obtained from the women for the study.

The authors declare no conflict of interest.

Peculiarities of the psychological state of pregnant women with HCV infection

Y.M. Zapopadna — 2024-10-25

Aim - to establish the peculiarities of the psychological status of pregnant women with HCV infection in order to prevent their disorders in the pre-pregnancy period.

Materials and methods. A prospective assessment of the psychological status of 100 patients, divided into two groups, was carried out: the Main group (МG) - 60 pregnant women with chronic hepatitis C (HCV infection) in the reactivation phase (with a positive result by the enzyme immunoassay method for anti-HCV), the control group (СG) - 40 healthy pregnant women. Pregnant women were offered to work with questionnaires using the following methods: assessment of parameters of the level of anxiety (HARS) according to Hamilton, assessment of well-being, activity and mood, questionnaire of quality of life SF-36. Statistical processing of research results was carried out using standard programs "Microsoft Excel 5.0" and "Statistica 8.0". Differences at p<0.05 are considered statistically significant.

Results. In the I trimester, pregnant women with HCV infection had an increased level of anxiety (Me (Q1-Q2)) as somatic (4.0 (0.5-6.0) and 0.0 (0.0-1.5), respectively CG; mental (4.0(2.5-6.0) and 1.0 (0.0-2.0), respectively; 0 (0.0-2.0), respectively. In the II trimester, there was a significant difference in total anxiety (10.0 (6.0-15.0) and 6.0 (2.0-11.0), respectively, in pregnant women with HCV infection when compared with healthy pregnant women in all parameters, especially due to the mental component (4.0 (2.0-7.0) and 1.0 (0.0-3.0), respectively. In the III trimester, a high level of differences was found only in the mental component, which on the median was 2 times higher than the level of mental anxiety in pregnant MG (4.0 (1.0-6.0) and 2.0 (0.0-3, 0), respectively; there was a decrease in the total quality of life (46.0 (42.0-51.0) and 52.0 (46.0-56.5), respectively, in all parameters, except for the family assessment (8.0 (6.0-8.0) and 8.0 (7.0-8.0)).

Conclusions. HCV infection during pregnancy is a risk factor for the development of anxiety and is characterized by an increase in the level of anxiety and a decrease in the quality of life throughout pregnancy, especially due to the mental component, which indicates the need to study the relationship between these factors and the frequency of complications during pregnancy, childbirth and postpartum period, as well as the condition of newborns in these women and possible ways of correcting the psychological status to reduce the frequency of obstetric and perinatal complications in the pre-gravid period.

No conflict of interests was declared by the author.

Peculiarity of vitamin D status in pregnant women

I.V. Poladich — 2024-10-25

The last decade can be called a "renaissance" of scientific interest in vitamin D research. The pleiotropic effects of vitamin D are impressive, particularly its impact on the pregnant woman and fetus. It has been established that an adequate level of vitamin D is necessary throughout pregnancy, starting from the moment of implantation and placenta formation.

Aim - to study the prevalence of vitamin D deficiency among pregnant women in the first trimester of gestation for the prevention of gestational complications.

Materials and methods. A clinical and laboratory examination of 1,051 pregnant women was conducted. The levels of 25-hydroxyvitamin D (25(OH)D) in the blood serum of pregnant women in the first trimester were determined using the enzyme-linked immunosorbent assay (ELISA). Statistical data analysis was performed using the "Statistica 13.3.721" software.

Results. In the first trimester of pregnancy, 87.9% of patients had critically low levels of 25(OH)D, indicating hypovitaminosis, while an optimal level of vitamin D was observed in only 12.1% of women. Severe vitamin D deficiency was found in 5.4% of pregnant women, deficiency in 45.8%, and insufficiency in 36.7% of women. Maternal age did not affect 25(OH)D levels in patients. The concentration of 25(OH)D in pregnant women who registered in the first trimester depends on the season, with the highest levels observed in spring. There is a correlation between body mass index (BMI) and 25(OH)D levels in the blood serum. A BMI >30 kg/m² significantly increases the risk of severe vitamin D deficiency.

Conclusions. A high percentage (87.9%) of vitamin D deficiency was found among pregnant women, prompting physicians to perform screening for 25(OH)D to identify risk groups for obstetric and perinatal complications and to enable timely correction.

No conflict of interests was declared by the author.

Evaluation of the efficiency of physical exercises for the elimination of diastasis of the rectus abdominal muscles in postpartum women

N.M. Kinash — 2024-10-25

Increased pressure on the muscles of the abdominal wall during pregnancy can often cause thinning and expansion of the white line of the abdomen, which is considered diastasis of the rectus abdominis muscles.

Aim - evaluation of the functional consequences and influence of physical exercises on diastasis of rectus abdominis muscles.

Materials and methods. We analyzed 54 patients who were diagnosed with diastasis recti during pregnancy and in the postpartum period. 26 women (the main group) after childbirth underwent a six-month rehabilitation program aimed at reducing diastasis (on average from the first to the seventh month after childbirth), 28 women (the control group) did not undergo a rehabilitation program after the birth of a child. Assessment of systemic complaints related to ventral hernia was carried out using a specialized questionnaire VHPQ (Ventral Hernia Pain Questionnaire), which allowed to assess the quality of daily activities.

Statistical processing of the material was carried out using the Excel 11 program The results were considered probable when the probability ratio was less than or equal to 0.05. The odds ratio was estimated, the confidence interval was set at 95% and defined as ±1.96 standard error.

Results. A statistically significant decrease in the width of the white line was observed in women of both groups 7-8 months after childbirth. Among patients of the main group, this was observed in 73.1% (19 people), and in the control group - in 64.3% (18 people), without a statistically significant difference between the groups. Conservative therapy of diastasis recti of the abdominal muscles made it possible to statistically significantly improve the quality of life of women after childbirth.

Conclusions. In 64.3% of women in the postpartum period, diastasis of rectus abdominis muscles resolves itself within 7-8 months and does not require treatment. A course of six-month physical rehabilitation makes it possible to raise this indicator to 73.1% unreliably. Conservative therapy of diastasis recti of the abdominal muscles in women in the postpartum period allows a statistically significant improvement in the quality of life of patients.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research.

The authors declare no conflict of interest.

Features of dry eye disease in women with menopausal syndrome

I.D. Skrypnychenko — 2024-10-25

Aim - to study the peculiarities of clinical manifestations of dry eye disease (DED) in women with menopausal syndrome.

Materials and methods. We examined 53 women. All patients were divided into 2 groups: The main group included 32 women aged 44 to 57 years with menopausal syndrome. The control group included 21 women aged 35 to 46 years with a normal menstrual cycle. The severity of the clinical course of menopausal syndrome was determined by a gynaecologist. The examination of women included: a test questionnaire for determining the ocular surface disease index, biomicroscopy of the cornea and conjunctiva, and diagnostic tests by Schirmer, Johnson, and Norn.

Results. Mild DED was diagnosed in 27 (84.4%) women of the main group, moderate in 5 (15.6%), and severe DED was not observed. Women in the control group were not diagnosed with DED. The most frequent complaints of women were: a feeling of ‘dryness’ in the eyes, which usually increased in the evening; painful reaction to instillation of indifferent eye drops into the conjunctival cavity; poor tolerance to wind, air-conditioned air, smoke; sand, foreign body under the eyelids, burning, and stinging in the eyes. The following objective clinical signs of DED were most often observed: reduced or absent lacrimal menisci at the eyelid margins; slow ‘unraveling’ of the eyelid conjunctiva and eyeball when the lower eyelid is pulled back; local edema of the eyeball conjunctiva with ‘creeping’ to the free edge of the lower eyelid; ‘sluggish’ hyperaemia of the eyelid conjunctiva. In the study of total tear production by Schirmer and basic tear production by Jones, a slight deficit was noted in women with mild DED, and in women with moderate DED, a pronounced deficit of tear fluid was noted. When assessing the stability of the tear film according to Norn, a slight decrease was noted.

Conclusions. The women with menopausal syndrome we examined had a deficit in total and basic tear production, decreased tear film stability, and developed subjective and objective clinical signs of mild to moderate DED. Clinical manifestations of DED, along with other menopausal disorders, can affect the quality of life of women. When determining the algorithm for the examination and treatment of these patients, it is advisable for gynaecologists to consider the peculiarities of the clinical course of DED, which may occur in the setting of menopausal syndrome.

No conflict of interests was declared by the authors.

The problem of the prevalence of smoking habit among adolescent girls

I.S. Lisetska — 2024-10-25

Today, smoking remains an urgent social and medical problem, a proven cause of many serious diseases (cancer, cardiovascular, respiratory, dental, etc.), and can have serious consequences for the reproductive system and fertility, disability and premature death, which humanity is able to prevent. The issue of the prevalence of smoking habits, especially among adolescent girls, remains relevant.

The aim is to study the prevalence of smoking habits among adolescent girls.

Materials and methods. An anonymous survey of 280 adolescent girls aged 18 to 24 years was conducted. The questions of the questionnaire were aimed at identifying the presence of a bad habit, the type of smoking, as well as finding out the age of initiation of smoking, the number of cigarettes smoked by the respondent, the reasons that prompted the start of smoking, awareness of the harmful effects on the human body, etc.

Results. Among all participants in the anonymous survey, 40.8±2.8% identified themselves as daily regular smokers. Another 14.6±1.8% of respondents indicated that they smoke from time to time. In addition, 21.5±2.3% of respondents admitted that they had tried to smoke at least once. It should be noted that only 23.1±2.1% of respondents have never smoked at all. Among the surveyed adolescent girls with a harmful habit, the majority indicated that they regularly use modern (alternative) types of smoking, namely 76.1±4.3%, which was 3.8 times more than the respondents who regularly smoke traditional cigarettes, respectively - 20.2±1.7% (p<0.05). The analysis of preferences for different modern types of smoking among those who use them showed that 32.5±2.8% smoke electronic cigarettes (VAPE) and 43.6±3.1% prefer tobacco heating systems (IQOS). A detailed analysis of the respondents' answers revealed that women mostly have a smoking history of 1 to 3 years - 46.7±4.1% and 3 to 5 years - 36.8±3.2% of respondents. In addition, it was found that 14.8±1.8% of girls reported smoking experience of up to 1 year. Only 1.7±0.2% of respondents reported smoking for more than 5 years.

Conclusions. The results of the study indicate a high prevalence of the harmful habit among adolescent girls. Important reasons for starting to smoke are the presence of smokers in the immediate environment (family, friends), which is a negative example, and a high risk of passive smoking. Advertising, stressful situations, and emotional stress also contribute to the emergence of a bad habit among respondents. At the same time, a significant number of respondents are aware of the harmful effects of smoking and have a desire to get rid of the habit.

The authors declare no conflict of interest.

Birth with abnormal placenta invasion: placenta accreta spectrum

N.M. Shemyakina — 2024-10-25

Childbirth by caesarean section has led to an increase in the number of women of reproductive age with an operated uterus. The frequency of placental invasion abnormalities in patients who underwent 1, 2, 3, 4 and 5 operations is 3%, 11%, 40%, 61%, 67%, respectively [1,2].

The aim - on the basis of the presented clinical case, demonstrate the approach in diagnosis, the use of endovascular blood-saving technologies and the involvement of a multidisciplinary team of doctors in the delivery of a pregnant woman with abnormal invasion of the placenta.

Clinical case. A woman with a diagnosis of Pregnancy III - 29 weeks + 4 days. A scar on the uterus after two previous cesarean sections. Complete placenta previa with abnormal invasion of the placenta (PAS II). Expected third birth. MRI of the pelvic organs: state after 2 caesarean sections with corresponding changes in the uterine wall in the form of significant thinning, with signs of partial ingrowth of the placenta tissue. Complete placenta previa with the cervical os overlapping. Planned caesarean section at 36 weeks 1 day. Stenting of the ureters, installation of an aortic occlusion balloon was performed. After that, a corporal caesarean section was performed. A girl was born weighing 2740 g with a height of 49 cm and an Apgar score of 8/9. A ligature was placed on the umbilical cord, and the placenta was left in place, the uterus was sewn up. After balloon occlusion of the aorta and inflation of the balloon, the separation of placentation defect in the lower segment of the uterus of 7x10 cm was started. Metroplasty of the lower segment of the uterus was performed. Anesthetic support - peripheral vascular access G16, epidural anesthesia. The transfusiologist was responsible for the blood preparations that were prepared in advance, the operation of the autohemotransfusion machine, the operation of the thromboelastograph, and periodic blood sampling for research. Monitoring showed stable indicators of hemodynamics with fluctuations relative to the initial data within 20%. Laboratory studies: Hb (g/l) - 116 → 90 → 64 → 91; Red blood cells ×10¹² - 3.59 → 2.73 → 1.88 → 2.92; Fibrinogen (g/l) - 6.38 → 5.7 → 3.55. Infusion of crystalloids - 3000 ml; colloids (gelatin) - 500 ml; autoerythrocytes – 615 ml (HCT=60); donor erythrocytes - 2 units (687 ml); fresh frozen plasma - 3 units (750 ml); albumin 25% - 200 ml; tranexamic acid was additionally administered - 1500 mg. Postoperative period without special features.

Conclusions. Careful preparation of the material and technical base, the involvement of a multidisciplinary team and the use of endovascular blood-saving technologies during operative delivery are the key to the successful performance of organ-saving operations. In this clinical case, despite the presence of a variant of placental ingrowth that is difficult to diagnose and surgically treat, it was possible to perform an organ-preserving operation.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Management of pregnancy with dichorionic diamniotic twins complicated by intrauterine death of one of the fetuses (literature review)

Yu.О. Dubossarska — 2024-10-25

Over the past decades, the number of multiple pregnancies has increased significantly due to the use of ovulation induction drugs in the treatment of infertility and the development of assisted reproductive technologies. This increases the relevance of the problem of single intrauterine death (SIUD) in the second or third trimester of pregnancy, which is associated with a significant increase in morbidity and mortality for the surviving twin. Complications include preterm birth, fetal growth restriction, and neurological complications in the surviving fetus.

Aim - to review current recommendations for SIUD in dichorionic diamniotic (DCDA) twins to select the most optimal tactics for managing such pregnancies.

For the review, we used Ukrainian and international recommendations on the management of multiple pregnancy, dedicated to the problem of SIUD, available on the electronic resources Pubmed, Semantic Scholar and UpToDate.

To date, there are no agreed guidelines worldwide on the management of multiple pregnancies complicated by SIUD. The opinion on SIUD in DCDA twins is particularly ambiguous, as the fetuses have separate placentas without vascular anastomoses and the prognosis for the surviving twin is more optimistic than in monochorionic twins. Most of the recommendations for SIUD in DCDA twins suggest a wait-and-see approach and prolongation of pregnancy to the fullest possible gestational age.

No conflict of interests was declared by the authors.