Aim: To reduce the frequency of obstetric and perinatal complications in women with multiple pregnancies by developing and implementing evidence-based diagnostic and therapeutic measures in the antenatal period. 

Material and methods: 86 pregnant women with diarrheal twins were monitore. On the basis of studying the premorbid background, somatic and reproduktive history, features of the gestational period, leading antenatal risk factors for the development of complications in multiple pregnancies were identified.  

Results: An analytical assessment of the importance of reproductive history in the development of gestational complications in women with multiple fertility has suggested that the number of late involuntary miscarriages increases the risk of miscarriage, the high proportion of preterm births in the history of 4 times increases the chances of miscarriage. The less pronounced deviation was demonstrated by the frequency of dead pregnancies, which was 2.6 times higher in multiple pregnancy, ectopic pregnancy, artific abortions.  Among the gestational complications, the threat of abortion in the group with monochorionic twins was noted in 52.7% of cases, with dichorionic twins – 57,0% of cases. Percentage of the threat of preterm labor was 5.8 times higher than the singlepregnancy rate, while in the group with monochorionic twins, its share was in 2.7 times more than in the case of dyhural. Iron deficiency anemia in the second half of pregnancy with multiple fertility was 53.0, which was almost four times the single-pregnancy rate. Preeclampsia in multiple pregnancy is almost 4 times more frequent (32.9%). The fraction of placental dysfunction with monochorionic twins was 53.3% and 33.8% for dichorionic twins. Fetal growth retardation during multiple pregnancy was 31.5% in monochorionic type, compared with 18.1% in women with dichorionic twins. Fetal distress during pregnancy with monochorionic twins was observed three times more than with dichorionic twins. The largest number of premature births was found in women with monochorionic twins and three times higher than dichorionic. At the same time, in the group with monochorionic type of placentation, the proportion of very early preterm labor was 4 times higher than that of the dichorionic twins. The frequency of early premature births with monochorionic twins was higher by almost three times – 31.5%, respectively, compared to 13.3%. The high frequency of operative deliveries is 56.4%, which is four times higher than single-pregnancy rates.

Conclusions: The leading antenatal factors of the risk of complications in multiple pregnancy are highlighted.