The article describes the history of the formation and development of the Ural School of Fetal Surgery. Currently, fetal surgeons of the Ural Research Institute for Maternal and Child Health have mastered a wide range of fetal surgeries: various interventions in monochorionic multiple pregnancy, anemia, fetal hydrops, obstructive uropathies, diaphragmatic hernia, oval window obstruction, intrauterine hydrocephalus, spinal hernias, fetal and placental tumors, and others. The range of fetal pathologies subject to intrauterine correction is expanding every year, new technologies are being developed and improved. Today, more than 15 fetal techniques have been introduced into the practice of the institute. Every year, the institute trains specialists from Russia and foreign countries, develops original domestic models of instruments and consumables for fetal surgery. The effectiveness of fetal surgical interventions is high — from 66 to 96%.

Objective. To review the current literature and highlight the modern approach to the diagnosis and treatment of twin reverse arterial perfusion syndrome (TRAP).
Materials and methods. The study used a literature review from the Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley, and Cochrane Library databases. A clinical case of reverse arterial perfusion is analyzed.
Results. The pathogenesis of the twin arterial perfusion syndrome was considered, and the causes of the error in the diagnosis of TRAP were highlighted. The basic ultrasound criteria for dynamic monitoring and evaluation of prognoses for a healthy fetus have been formed. Possible management tactics for these patients are highlighted, depending on the clinical situation, as well as possible correction methods for the progression of TRAP.
Conclusion. An analysis of the literature data has shown that there are different approaches to the monitoring and treatment of TRAP, at the moment there is an unequivocal opinion that early diagnosis, comprehensive monitoring, and timely surgical treatment with the progression of TRAP are necessary. Further study of ultrasound signs of progression of twin arterial perfusion syndrome and the development of clear algorithms for monitoring and surgical treatment will improve perinatal outcomes for a healthy fetus (fetus-pump).

Summary. Congenital anemia represents a significant challenge in perinatal diagnostics due to its high prevalence and the risk of severe complications in both the fetus and the neonate. Therefore, the study and advancement of diagnostic and therapeutic approaches for fetal anemia remain a critical priority in modern perinatology.
Objective. To present a modern approach to the diagnosis and treatment of congenital anemia in the fetus and newborn based on an analysis of current literature data and a clinical case.
Materials and Methods. A literature review over the past 10 years was conducted using databases such as Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley, and the Cochrane Library. A clinical case of discordant dichorionic twins with severe anemia in one of the fetuses was analyzed.
Results. T he m ain c auses o f c ongenital a nemia w ere c onsidered, i ncluding i soimmunization, fetal blood loss, intrauterine infection, genetic and neoplastic diseases. The key role of non-invasive diagnosis of fetal anemia through the measurement of peak systolic velocity in the middle cerebral artery was emphasized. The effectiveness of intrauterine blood transfusion as the primary treatment method for severe anemia was demonstrated. The clinical case illustrated the complexities of differential diagnosis associated with the potential development of anemia-polycythemia syndrome in dichorionic placentation, as well as the impact of intrauterine infection and umbilical cord pathology on anemia formation. Timely prenatal diagnosis, intrauterine transfusions, and subsequent postnatal treatment ensured a favorable perinatal outcome.
Conclusion. The analysis of literature and the clinical case demonstrate the importance of a timely multidisciplinary and individualized approach to the diagnosis and treatment of congenital anemia using modern ultrasound technologies and intrauterine interventions to improve the prognosis for fetuses and newborns.

The aim of this study is to evaluate the accuracy of noninvasive diagnosis of moderate and severe fetal anemia using various diagnostic algorithms.
Materials and methods. To evaluate the effectiveness of various algorithms for the noninvasive diagnosis of fetal anemia, 2 groups were formed, which included 70 pregnant women (one dichorionic twins). There were examined 71 fetuses. According to hematological tests of the fetus, the following groups were formed: “Anemia” — fetuses with moderate or severe anemia (n = 16, pregnant — 16) and “Norm” — fetuses with mild anemia or without anemia (n = 55, pregnant — 54, one dichorionic twins). Peak systolic velocity in the middle cerebral artery (PSV CMA) and fetal cardio-thoracic ratio (CTR) were measured by ultrasound. The results were analyzed by Statistica 10 program.
Results. The proposed author’s diagnostic method that includes 2 parameters (PSV MCA and CTR) shows higher diagnostic accuracy (98.6% / 85.9%, p = 0.009), specificity (98.2% / 81.8%, p = 0.008) and predictive value of a positive test (94.1% / 61.5%, p = 0.03) in comparison with the method that includes only 1 parameter (PSV MSA).
Conclusion. Noninvasive diagnosis of moderate and severe fetal anemia using two criteria (PSV MCA and CTR) provides higher efficiency in comparison with previous methods based only on the definition of PSV MCA.

Introduction. Arteriovenous malformation of the vein of Galen (AVM VG) is a rare vascular malformation of the central nervous system, mainly diagnosed in the neonatal or postnatal period. Despite significant advances in the field of neonatal endovascular embolization, the mortality rate and the incidence of severe neurological complications remain high. In this regard, the development of intrauterine surgical technologies opens up prospects for interventions aimed at preventing cardiovascular complications and hypoxic damage to the central nervous system. Objective: Development of a method for intrauterine partial occlusion of arteriovenous malformation of the vein of Galen under ultrasound control in an experiment.
Materials and methods. The method of minimally invasive intrauterine embolization of arteriovenous malformation of the vein of Galen refers to the methods of fetal surgery, leads to a decrease in blood shunting and relief of cardiovascular insufficiency. The model of malformation was the left atrium of a sheep fetus. The use of this technique was approved at a meeting of the Ethics Committee of the Ural Research Institute of Occupational Medicine of the Ministry of Health of the Russian Federation on September 12, 2021.
Study results. During two experimental interventions on the model of arteriovenous malformation of the vein of Galen, modeled on sheep fetuses, partial intrauterine embolization was successfully performed using microspirals and adhesive compositions. It was found that this technique provides a significant decrease in the blood flow velocity in the chambers of the heart (by 3-4 times), without intraoperative disturbances in the cardiac activity of the fetuses. The use of an adhesive composition prevented the migration of spirals. All fetuses remained alive at the end of the experiments.
Conclusion. The proposed technique of partial intrauterine embolization of arteriovenous malformation of the vein of Galen in the experiment showed potential effectiveness in reducing blood flow through the aneurysmally altered vessel. The obtained data confirm the possibility of safe administration of embolic material under ultrasound control, which allows us to consider this approach as a promising stage of preparation for intrauterine treatment of this pathology in high-risk fetuses. Further studies are needed to clarify the criteria for selecting patients and assess the clinical effectiveness of the proposed method.

Summary. Despite recent advances in medicine, polyhydramnios occurs in 1–2% of pregnancies worldwide and is associated with a high risk of perinatal complications, accounting for 13–17% of perinatal mortality. In recent years, the rate of cesarean section among pregnant women with acute polyhydramnios has increased to 60–75%. Furthermore, *“...perinatal mortality in pregnancies complicated by polyhydramnios is reported to be 2.3 times higher” [1].
The purpose of the study. To assess the effectiveness of amnioreduction using a universal intrauterine port compared to the standard method in pregnant women with acute polyhydramnios.
Materials and Methods. An analysis was conducted on obstetric and perinatal outcomes in 55 patients divided into a main group (N=21) and a comparison group (N=34). The main group underwent prolonged amnioreduction using a universal port, while the comparison group received repeated standard amnioreductions.
Results. The study revealed significantly better outcomes in terms of pregnancy prolongation and perinatal results in the main group. Perinatal outcomes analysis showed the advantage of using a universal port for amnioreduction. In the main group, 61.9% of newborns had a birth weight ≥2500 g, and 57.1% had an Apgar score of 8–10; no perinatal losses were recorded. In the comparison group, only two newborns had a birth weight ≥2500 g or an Apgar score of 8–10; there were 2 antenatal and 3 early neonatal deaths. Based on the analysis, it was established that the group undergoing amnioreduction with a universal intrauterine port showed higher birth weight, normal fetal growth, higher Apgar scores, and no perinatal losses.
Conclusion. In the main group, the use of a universal intrauterine port for amniodrainage in severe polyhydramnios was associated with a reduction in perinatal morbidity and mortality compared to the standard amnioreduction method. The comparison group demonstrated lower birth weight, lower Apgar scores, and higher mortality rates. This confirms that amnioreduction using a universal port plays an important role in improving perinatal outcomes and is an effective method for treating polyhydramnios.

Summary. Chorioangiomas, or placental hemangiomas, are the most common benign placental tumors, with an incidence of 0.2–139 cases per 10,000 births.
The purpose of this article. To describe a case of detection of a large horangioma.
Materials and methods. Ultrasound examination protocols and ultrasound images were used.
Results. This case illustrates the importance of early diagnosis of this pathology and the correct management strategy.
Conclusion. Ultrasound remains the primary method for diagnosing this condition. Timely medical consultation, early diagnosis, and appropriate management help reduce the number of perinatal losses associated with this pathology.

Summary. Specific complications of monochorionic multiple pregnancy affect both the antenatal development of the fetus and the period of early neonatal adaptation, which is accompanied by metabolic status disorders.
The purpose of the study. To study metabolic parameters (according to routine indicators of biochemical blood analysis and metabolic indices) in premature infants from monochorionic twins in the period of early neonatal adaptation.
Materials and methods. The study was carried out at the Research Institute of Obstetrics and Maternity Care of the Ministry of Health of the Russian Federation from 01.01.2018 to 31.12.2024. The study included 1230 premature monochorionic diamniotic (MCDA) twins of gestational age 22/0-36/6 weeks.
Results and discussion. Differences were found between the groups of MHD twins with complicated and uncomplicated antenatal periods in the following parameters: total protein, g/l (group 1 — 41.0 (34.6-46.0); group 2 — 40.0 (36.0-46.0); group 3 — 44.0 (40.0-48.0); p<0.0001), albumin, g/l (group 1 — 29.3 (25.3-31.9); group 2 — 29.0 (27.0-31.4); group 3 — 30.1 (28.5-32.5); p<0.0001), AST U/l (group 1 — 58.0 (43.3-82.0); group 2 — 52.0 (40.0-75.0); 3rd group — 43.0 (34.0-56.0); p<0.0001), hypoglycemia (1st group — 162 (67.5%), 2nd group — 180 (65.2%), 3rd group — 396 (55.5%) p=0.002 and p=0.006, respectively), as well as a number of biochemical indices.
Conclusions. The presented assessment of the metabolic status in the group of premature MCDA twins with complicated antenatal period revealed significant changes in the studied parameters, indicating the development of neonatal dysmetabolic syndrome.