Kune marudzi akasiyana epamuviri pemapatya zvichienderana nenzira yekubata uye kuiswa kwechibereko. Saka tinosiyanisa:

- monozygotic twins (inenge 20% yemimba yemapatya) inokonzerwa nekusangana kwezai rimwe chete nembeu. Muvhiki yekutanga yenhumbu, zai rinopatsanurwa kuita zvidimbu zviviri izvo zvinozokura zvakasiyana. Iyo genetic zvinhu zvevaviri "fetus" zvakafanana: mapatya emurume mumwe chete anozotaridzika zvakafanana, saka izwi rekuti "mapatya akafanana". Pakati peizvi monozygous pamuviri, kunewo marudzi akasiyana-siyana ekugadzirisa zvichienderana nenguva yekuparadzaniswa kwezai, achiziva kuti gare gare inoparadzanisa, iyo inoswedera pedyo mazai anoramba aripo uye anogovera pamuviri annexes.

• kana kuparadzana kukaitika mazuva asingasviki maviri mushure mekusangana, zai rega rega rinenge rine placenta nehomwe yeamniotic. Tinobva tataura nezve bichorial twin pregnancy (two placentas) uye biamniotic (mahomwe maviri amniotic).
• kana kupatsanurwa kunoitika pakati pezuva rechitatu ne3, kuiswa kuchava monochorial (imwe placenta) uye biamniotic (mabhegi maviri amniotic). Mapatya anogovera placenta imwe chete iyo inopinzwa tambo mbiri dzeguvhu.
• kana kuparadzaniswa kuchiitwa mushure mezuva re8, kuiswa kune monochorial (a placenta), monoamniotic (amniotic pocket).

- dizygotic mapatya (80% yemimba yemapatya) inokonzerwa nekusangana kwemazai maviri, rimwe nerimwe nembeu yakasiyana. Havana maitiro akafanana uye anogona kunge ari emhando imwe chete kana yakasiyana. Vanotaridzika zvakafanana sehanzvadzi mbiri kana hanzvadzi dzinotaridzika zvakafanana. Mumwe nemumwe ane placenta yavo nehomwe yavo yeamniotic, saka ibhichorian uye biamniotic nhumbu. Yekutanga trimester Ultrasound inogona kuona mapatya pamuviri nekuratidza mabhegi maviri ekuzvitakura. Anoitawo kuongororwa kwechorionicity (imwe kana maviri placentas), kuongororwa kwakakosha zvikuru nokuti kunotungamirira kune zvakasiyana-siyana maererano nezvinetso uye naizvozvo nzira dzekuongorora pamuviri.

Mimba yemapatya inoonekwa senjodzi yekuzvitakura. Tinocherechedza kunyanya:

• kuwedzera kwenjodzi ye intrauterine growth retardation (IUGR), zvikuru nekuda kwekugovana kwe "fetus" zviwanikwa zvishoma zve placenta kana kusagadzikana kwekufamba kweropa panguva yekunonoka kubata pamuviri. Iyi IUGR inokonzeresa neonatal hypotrophy (huremu hwekuzvarwa), inowanzoitika mumapatya.
• kuwedzera kwengozi yekuberekwa kusati kwasvika. 20% yevana vasati vasvika vanobva mumimba dzakawanda uye 7% yemapatya vana vasati vasvika (2), vane vese varindiri kufema, kugaya uye neurological pathologies inokonzerwa nekusati kwasvika.
• kuwedzera kwengozi yekufa kwepamuviri, 5 kusvika ku10 nguva yakakwirira mumimba yemapatya pane pamuviri mumwechete (3).
• kuwedzera kwengozi ye toxemia yekuzvitakura. Mupamuviri pemapatya, hypertension inowanzoitika ka4, uye inogona kukonzera kuderera kwekukura mumwana mumwe chete kana vese.

Kudzivirira uye kuona matambudziko aya nekukasira, nhumbu dzemapatya dzinoiswa pasi pekutariswa kwakawedzerwa nemurapi ane ruzivo rwakanaka rwerudzi urwu rwemimba. Ultrasound uye dopplers zvinowanzoitika, neavhareji yemwedzi wega wega, kana kutopfuura kana paine musiyano mukuru mukukura pakati pevacheche. Amai vemangwana vanoiswawo kuzorora kare nezororo rekurwara kubva kumavhiki makumi maviri.

Zvichienderana nekwavanogara, mamwe mapatya epamuviri anogona kupawo njodzi. Mumimba yemonochorial (placenta imwe chete yevacheche), dambudziko rinotyiwa ichirwere chetransfusion-transfused (TTS), chinobata 15 kusvika 30% yenhumbu idzi (4). Ichi chirwere chinoratidzwa nekusapararira kweropa pakati pevaviri "fetus": imwe inogamuchira yakawandisa, imwe haina kukwana. Bi-mwedzi kana kunyange vhiki nevhiki ultrasound yekutarisa inodiwa kuitira kuti uone ichi chinetso nekukurumidza.

Muchiitiko che monoamniotic monochorial pamuviri, imwe njodzi inowedzerwa kune yeTTS: iyo yekusungirirwa kwetambo. Sezvo pasina kupatsanurwa pakati pevacheche vanogovera chikwama chimwe chete cheamniotic, guvhu ravo rinogona kumonyoroka pakati pawo. Kuwedzera kwekutarisa kunodiwa kubva pa22-30 WA.

Kana imwe yenjodzi dzepamuviri papatya iri kuzvara mwana nguva isati yakwana, zvisinei, munhu haafanire kuenda kure zvakanyanya mukuenderera mberi kwenhumbu yekukura kwakanaka kwemapatya maviri anoisa mungozi, pakupera kwemimba, yekusawana zvakakwana. kamuri kana amniotic fluid. Mimba yemapatya ipfupi pane nhumbu imwe chete. Padanho rekufema, mapatya akakura mavhiki maviri pamberi pevacheche kubva pamimba imwe chete (5).

Mukurudziro dzayo dzekutonga kwepamuviri mapatya, CNGOF nokudaro inorangarira mazuva ekupedzisira anotevera:

- muchiitiko chemimba isina kuoma bichorium, kuberekwa, kana zvisati zvaitika kare, inowanzorongwa pakati pemavhiki makumi matatu nemasere nemavhiki makumi mana.

- kana paine isina kuomesesa biamniotic monochorial pamuviri, kusununguka kunorongwa pakati pe36 WA uye 38 WA + 6 mazuva.

- muchiitiko che monoamniotic monochorial pamuviri, zvinokurudzirwa kubereka mapatya aya kunyange kare, pakati pevhiki 32 ne36.

Kana iri nzira yekusununguka, chikamu chevhavha kana cesarean, "hapana chikonzero chekukurudzira imwe nzira yekuendesa kupfuura imwe muchiitiko chekuzvitakura kwemapatya pasinei nenguva yayo", inoratidza CNGOF. Nokudaro, mimba yemapatya haisi chiratidzo chakasimba chechikamu checesarean, kunyange pachiitiko chekuratidzwa mubeche rekutanga mapatya kana chiitiko chechibereko chine vanga.

Nzira yekusununguka ichasarudzwa maererano nenguva yekuzvitakura, uremu hwevana, nzvimbo dzavo (zvinoonekwa pa ultrasound), hutano hwavo, chorionicity, hupamhi hwechiuno chemangwana amai. Muchiitiko chekukurumidza kusati kwasvika, kunonoka kukura kwakanyanya, kusingaperi kushushikana kwe fetal, monochorial monoamniotic pamuviri, cesarean chikamu chinowanzoitwa pakarepo.

Kuzvarwa kwemapatya kunoramba kuri panjodzi, sepamuviri pemapatya. Muyero wezviridzwa zvekushandisa uye cesarean chikamu chakakwirira kudarika pamuviri mumwe chete. Ngozi yekubuda ropa panguva yekusununguka inowedzerawo nokuti iyo placenta yakakura uye chibereko, chakanyanya kuparadzaniswa, chibvumirano chisinganyanyi kubudirira, chichidzivisa chiitiko chekugadzirisa kwechisikigo chemidziyo miduku yechibereko.

Kana nzira yakaderera ikaedzwa, inoitwa muchikamu cheKesariya neine obstetrician gynecologist ane ruzivo mukuberekwa kwemapatya uye yeanesthesiologist.

Mukuwedzera, zvose zvinofanira kuitwa kupfupisa nguva pakati pekuzvarwa kwevana vaviri, nokuti mapatya echipiri anonyanya kutarisana nezvinetso zvakasiyana-siyana zvekuzvara mwana: kuratidzwa kusina kunaka, kutadza kushanda, kutambura kwe fetal kunotevera chikamu chechikamu che placenta mushure mekuberekwa. . kuberekwa kwemwana wekutanga, kuberekwa kwetambo, nezvimwewo.