Проведен систематический анализ данных в современной литературе принципов диагностики, тактики ведения, роли ангиогенных факторов в осложнениях монохориальной многоплодной беременности. В статье описаны этиология, современные стандарты диагностики, дифференциальная диагностика, тактика ведения беременности при таких осложнениях монохориального типа плацентации, как фето-фетальный трансфузионный синдром, селективная задержка роста плода. Авторами проведен анализ публикаций о роли ангиогенных факторов роста в развитии фето-фетального трансфузионного синдрома и селективной задержки роста плода. Необходимо проведение дальнейших исследований в области изучения роли ангиогенных факторов роста в развитии осложнений монохориальной многоплодной беременности. Ключевые слова: фето-фетальный трансфузионный синдром, монохориальная диамниотическая двойня, селективная задержка роста плода, фетоскопическая лазерная коагуляция плацентарных анастомозов.

Introduction. In recent years, the problem of multiple fetuses has become particularly important, which is associated with a steady increase in the frequency of multiple pregnancies worldwide. The feto-fetal transfusion syndrome (FFTS) is a classic example of unbalanced functioning of placental anastomoses, which leads to transfusion between fetuses. The incidence of this syndrome in a group of monochorionic diamniotic twins ranges from 8% to 15% and, in the absence of timely diagnosis and intrauterine correction, leads to death of one or both fetuses in 70-100% of cases. The effect of different methods of intrauterine surgical correction of FFTS in monochorionic diamniotic multiple fetuses on perinatal outcomes is of scientific interest. Purpose of the study — to investigate the effect of different types of laser coagulation of placental anastomosis (LCPA) on perinatal outcomes in intrauterine surgical correction of FFTS. Materials and methods. Depending on the surgical technique used, women were divided into three groups: the total placental anastomosis coagulation method, Group 1 (58 pregnant women); the selective placental anastomosis coagulation method, Group 2 (67 pregnant women); the sequential selective laser coagulation of placental anastomoses, Group 3 (62 pregnant women). Results. We analyzed the results of intrauterine surgical correction of FFTS by different methods of laser coagulation of placental anastomoses in 187 women with monochorionic diamniotic type of placentation of II-IV degrees according to Quintero. We obtained statistically significant differences in many perinatal period indices depending on the LCPA method used. Discussion. Sequential selective LCPA has proven to be the most effective, safe, and promising technique for correction of FFTS. The data obtained indicate possible ways to improve pregnancy prolongation and fetal survival rates after the use of intrauterine surgical correction of placental vascular anastomoses. Conclusion. Sequential selective LCPA has proven to be the best technique to correct FFTS with the least perinatal losses and postoperative complications, as well as the highest efficacy.