INFLUENCE OF MATERNITY HOSPITALS LEVEL ON MATERNAL MORTALITY
Keywords:
maternal mortality, referral of pregnant women, regionalization of obstetric care, maternity hospital levels, obstetric hemorrhage, preeclampsia, cesarean sectionAbstract
Reducing maternal mortality is one of the priority tasks in the world. Objective: to determine the impact of the level of maternity institutions on maternal mortality. Materials and methods. A retrospective analysis of 260 cases of maternal death in 2021-2022 in the country was conducted. Results. The main causes of maternal mortality were direct obstetric causes: obstetric hemorrhage 22.3%, preeclampsia 15%, thromboembolic complications 14.6%, genital sepsis 11.1%, anesthesia complications 2.3%, anaphylactic reactions 2.3%. Indirect maternal mortality from somatic diseases was 25.4%. Most maternal deaths occurred in low-level maternity hospitals: in 2021 - 37.9%, and in 2022 - 50.76% of maternal deaths occurred in district maternity wards. In 2021, 28.7% of maternal deaths occurred in city maternity hospitals, in 2022 - 26.15% of cases of maternal deaths, in level 3 institutions: in regional perinatal centers - 23.2% and 19.2%, in republican institutions - 6.3% and 3.1% of cases of maternal deaths. Conclusions. The risk of maternal mortality was higher in institutions with a lower level of obstetric care. Pregnant women with a high risk of complications during pregnancy, childbirth and the postpartum period should be identified in the antenatal period and referred to higher-level institutions where they can receive quality care that matches their risk level.
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