Fetal Medicine: Literature Review and the Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine

Introduction. Twin reversed arterial perfusion (TRAP) syndrome is one of the types of complications of monochorial twins (MT) with a frequency of occurrence of 1:35000 births. It is characterized by the presence of the main vessel instead of a normal 4 chambers heart and intrauterine developmental abnormalities. This pregnancy requires monitoring using dynamic ultrasound diagnostics every 7 days, in accordance with current recommendations. The treatment is intrauterine laser coagulation of blood vessels of the “acardial fetus” (AP) in order to prevent the development of a threatening condition for the “fetal pump” (PP). Aim: to demonstrate the possibilities of comprehensive conservative management of monochorial pregnancy complicated by TRAP.Materials and methods. An ultrasound examinations were performed on a weekly basis in monochorionic pregnancy, complicated by TRAP within the period 12-38 weeks. Serum concentrations of biochemical markers PAPP-A (pregnancy-associated plasma protein-A) and β-hGC (β-subunit of human chorionic gonadotropin) were studied in the first trimester to predict adverse perinatal outcomes.Results. The possibility of prolonging a pregnancy complicated by TRAP without performing intrauterine surgical intervention, during which quite serious complications can occur in this category of pregnancies, has been demonstrated. In a patient with monochorionic twins complicated by TRAP, totally 27 ultrasound examinations were performed within the period 12-38 weeks. This approach made it possible to dynamically monitor the condition of a pregnant and healthy fetus and to prolong pregnancy without surgery until the full term.Conclusions. Following the existing guidelines, without tailoring for individual risk, may lead to an unreasonable increase in surgical interventions. In turn, surgery is not only accompanied by a high risk of complications (up to 15%), but also constitute a certain financial burden on the budget, determined by the state on the level of 208,000 rubles. Performing routine ultrasound examinations according to the examination protocol for monochorionic pregnancy will contribute to avoiding the complications associated with surgery and better selection for surgery as well as reducing the government costs.

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Problems of liability for injury to the health caused by the use of genome editing systems of germ line cells

Belova

2023

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The problem of the admissibility of compensation for harm caused to the health of a person by an act committed before his birth, in particular, due to editing of the genome of human germ line cells, is investigated. It is argued that in the case of a live birth, a child acquires the right to compensation for property and moral damage caused by an act committed before his birth. It is substantiated that such an act is illegal, as violating an objective right and encroaching on an intangible good (health) protected by law. Due to the fact that the modern level of development of science and medicine allows to directly affect human health long before it is born, such an intangible good as health should begin its legal existence "in anticipation" of the subject of civil law due to its special significance for the future participant of property and personal non-property relations that constitute the subject of civil law regulation.

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Fetal Medicine: Literature Review and the Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine

Cited by 5 publications

References 17 publications

Fetus-acardius: two observations from practice with a brief literature review

Fetus-acardius: two observations from practice with a brief literature review

Health technology assessment in obstetrics: advantage of tailored conservative strategy vs surgical therapies of monochorionic twin complicated by TRAP-sequence

Problems of liability for injury to the health caused by the use of genome editing systems of germ line cells

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