Evaluation of the effectiveness of care for pregnant women with critical obstetric conditions in the maternal mortality reduction strategy

   Introduction. In the Russian Federation (RF), in 2021, the Ministry of Health of Russia approved the Regulations and Monitoring of Critical Obstetric Conditions (COC), which includes patients with COC in a specialized system and defines its role in obstetric practice.

   Objective. To prove the effectiveness of early diagnosis and routing of critical obstetric conditions in reducing the maternal mortality rate from obstetric hemorrhage, preeclampsia, and septic complications (from COVID-19) in the western medical zone of the Khanty-Mansi Autonomous Okrug — Yugra.

   Materials and methods. At the first stage, a study of demographic indicators was conducted in the Russian Federation (RF), the Ural Federal District (UFD), and the Khanty-Mansi Autonomous Okrug (KhMAO) over the past 10 years. At the second stage, a single-center retrospective comparative study of the medical records of women in a level 3 perinatal center (PC) was conducted. At the third stage, a study of the level of angiogenic growth factors in the 3^rd trimester of pregnancy was conducted in the prospective analysis group to assess the prognosis of severe PE and determine the timing of delivery, taking into account the clinical manifestations of PE and the indicators of biochemical screening in the first trimester. Statistical analysis was performed using Statistiсa 10 (USA) and StatTech v. 2.8.4 (Stattech LLC, Russia, 2020).

   Study results. The structure of obstetric complications among pregnant women from healthcare facilities within the Khanty-Mansiysk Regional Clinical Hospital’s perinatal center’s area of responsibility in 2022 is presented in descending order: EGD, including diseases caused by SARS-CoV-2 infection (48.0%), preeclampsia (31.3 %), obstetric hemorrhage (11.2 %), and septic complications (7.8 %). Moreover, over the past decade, there has been an increase in the number of pregnant women classified as obstetric complications and referred for delivery to the Khanty-Mansiysk Perinatal Center, which has made it possible to avoid maternal losses, including those from COVID-19 and its complications, over the past 9 years. At the same time, the number of births, as elsewhere in the Ural Federal District and the Russian Federation, is declining: by 31.1 % over the past 10 years. According to data from the western medical zone of the Khanty-Mansi Autonomous Okrug, the survival rate was 100 %, and the mortality rate was zero, including from SARS-CoV-2 infection and its complications.

   Conclusion. The existing resources of the perinatal center at the Khanty-Mansi Autonomous Okrug Multidisciplinary Hospital, despite the increasing age of reproductive function of patients and the number of pregnant women with comorbid pathologies, allow for more effective provision of specialized medical care. A multidisciplinary approach to assessing the severity of CAS patients, including those with SARS-CoV-2 coronavirus infection, has prevented fatal maternal outcomes in patients in the assigned area.

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