transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2017-4-4-36-42transmed-247Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯСОВРЕМЕННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ ФЕТО-ФЕТАЛЬНОГО ТРАНСФУЗИОННОГО СИНДРОМАCURRENT TREATMENT OF TWIN-TO-TWIN TRANSFUSION SYNDROMEОвсянниковФ. А.OvsyannikovF. A.

к.м.н, врач акушер-гинеколог,

ул. Аккуратова, д. 2, Санкт-Петербург, 197341

PhD, obstetrician-gynecologist,

Akkuratova str. 2, Saint Petersburg, 197341

sivers1@yandex.ruРомановскийА. Н.RomanovskyA. N.

акушер-гинеколог родильного отделения;

аспирант кафедры акушерства и гинекологии им. С. Н. Давыдова,

Санкт-Петербург

obstetrician-gynecologist, PhD student;

Saint Petersburg

artemrom@yandex.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В. А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research CentreRussian FederationСанкт-Петербургское государственное бюджетное учреждение здравоохранения «Родильный дом 17»; Федеральное государственное бюджетное образовательное учреждение высшего образования «Северо-Западный государственный медицинский университет им. И. И. Мечникова» Минздрава РоссииРоссияMaternity Clinic 17; North-Western State Medical University named after I. I. MechnikovRussian Federation201702102017443642Copyright © Овсянников Ф.А., Романовский А.Н., 20172017Овсянников Ф.А., Романовский А.Н.Ovsyannikov F.A., Romanovsky A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/247

Фето-фетальный трансфузионный синдром – тяжелое специфическое осложнение монохориального многоплодия, которое развивается примерно в 10-15% монохориальных двоен. Целью настоящего обзора является представление современного взгляда на подходы к лечению и наблюдению беременности, осложненной фето-фетальным трансфузионным синдромом. При выжидательной тактике перинатальная смертность при фето-фетальном трансфузионном синдроме достигает 95%. Для лечения применяются фетоскопическая лазерная коагуляция анастомозов плаценты, амниоредукция, селективная редукция одного плода из двойни или прерывание беременности. Наиболее эффективной методикой считается фетоскопическая лазерная коагуляция сосудистых анастомозов плаценты, которая обеспечивает наиболее высокую выживаемость плодов и благоприятные отдаленные исходы для плодов, при этом имеет минимальный риск осложнений для матери. При фето-фетальном трансфузионном синдроме I стадии обсуждается эффективность трансабдоминальных амниоредукций, которые в некоторых случаях приводят к дальнейшему разрешению ФФТС. Внутриутробные вмешательства позволяют лечить аномальные состояния плода и плаценты, предотвращая развитие заболеваний в детском и взрослом возрасте. 

Twin-to-twin transfusion syndrome – severe specific complication of monochorionic pregancy, which occurs in 10—15% monochorionic twins. The object of this paper is describing current treatment modalities of twin-totwin transfusion syndrome. Perinatal loss in case of conservative approach in twin-to-twin transfusion syndrome is more than 95%. Fetoscopic laser coagulation, amnioreduction, selective fetocide and preganancy termination are the current atreatment modalities of twin-to-twin transfusion syndrome. Fetoscopic laser coagulation is considered the most effective approach with highest rates of livebirth and the lowest maternal risks. In I stage twin-to-twin transfusion syndrome transabdominal amnioreductions can be effective, leading to resolving the disease. Intrauterine fetal surgery is the treatment of choice, preventing future morbidity in childhood and adolescence.

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The Fetus and Neonate as the Patient. SPb.: «Petropolis», 2015: 931-935. In Russian [Михайлов А.В., Романовский А.Н., Шлыкова А.В. Гибель одного из плодов при многоплодии. Плод и новорожденный как пациенты. ИД “Петрополис”, Санкт-Петербург, 2015: 931-935].Mikhailov AV, Romanovsky AN, Kashtanova TA. Experience of placental anastomoses laser coagulation in twin-to-twin transfusion syndrome. Vestnik Ros. Voennomedicinskoy akademii. 2016; 3 (55):47-50. In Russian [Михайлов А.В., Романовский А.Н., Каштанова Т.А. Опыт применения лазерной коагуляции сосудистых анастомозов плаценты при фето-фетальном трансфузионном синдроме. Вестник Российской военно-медицинской академии. 2016; 3(55):47-50].Mikhailov AV, Romanovsky AN, Kashtanova TA. Experience of placental anastomoses laser coagulation in twin-to-twin transfusion syndrome. Vestnik Ros. Voennomedicinskoy akademii. 2016; 3 (55):47-50. In Russian [Михайлов А.В., Романовский А.Н., Каштанова Т.А. Опыт применения лазерной коагуляции сосудистых анастомозов плаценты при фето-фетальном трансфузионном синдроме. Вестник Российской военно-медицинской академии. 2016; 3(55):47-50].Mikhailov AV, Romanovsky AN, Kashtanova TA. Placental anastomoses laser coagulation in twin-to-twin transfusion syndrome. Tavricheskii medico-biologocheskiy vestnik. 2016; 19(2):167-171. In Russian [Михайлов А.В., Романовский А.Н., Каштанова Т.А. Применение лазерной коагуляции сосудистых анастомозов плаценты при фето-фетальном трансфузионном синдроме. Таврический медико-биологический вестник. 2016; 19 (2):167-171].Mikhailov AV, Romanovsky AN, Kashtanova TA. Placental anastomoses laser coagulation in twin-to-twin transfusion syndrome. Tavricheskii medico-biologocheskiy vestnik. 2016; 19(2):167-171. In Russian [Михайлов А.В., Романовский А.Н., Каштанова Т.А. Применение лазерной коагуляции сосудистых анастомозов плаценты при фето-фетальном трансфузионном синдроме. Таврический медико-биологический вестник. 2016; 19 (2):167-171].

The authors declare that there are no conflicts of interest present.