Efferent therapy for dichorionic diamniotic twin pregnancy resulting from IVF, complicated by isthmic-cervical insufficiency

Background: Dichorionic diamniotic twin pregnancy resulting from IVF can lead to isthmic-cervical insufficiency with concomitant complications. Against the background of the initial genital chronic infection in a woman there is a threat of septic complications for the mother-fetal couple. The complex pathology is accompanied by an accumulation of toxic substances in the mother-placenta-fetus system that requires pathogenetic treatment measures.

Clinical Cases: This paper presents data on the results of efferent therapy in two pregnant women with dichorionic diamniotic twin pregnancy complicated by fetal bladder prolapsing into the cervical canal up to the external pharynx (1 case) and with premature amniotic fluid outflow of the first fetus (2 cases). The patients received preserving therapy at the hospital and then were transferred to the perinatal center with the clinical signs of threatening abortion, endotoxemia, and moderate inflammatory response, which were treated with efferent therapy in the form of medium-volume membrane plasmapheresis combined with photodilution with ultraviolet and laser beams. There were no complications during efferent therapy. In 1 and 2 observations the pregnancies of women in the perinatal center were prolonged by 45 and 34 days with operative delivery at 27 and 31 weeks, respectively. There were no septic complications in women and children. The newborn premature infants after therapeutic and rehabilitative measures had good prospects for a full life.

Conclusion: The efferent therapy methods are safe and, in cases of IVF-infant foetuses with complicated isthmic-cervical insufficiency, are a pathogenetic measure; they help to prolong pregnancy and prevent infectious complications in the mother and fetus.