maternal mortality- one of the main criteria for the quality and level of organization of the work of obstetric institutions, the effectiveness of the introduction of scientific achievements in healthcare practice. However, most leading experts consider this indicator more widely, considering maternal mortality as an integrating indicator of the health of women of reproductive age and reflecting the population outcome of the interactions of economic, environmental, cultural, socio-hygienic and medical-organizational factors.
This indicator allows you to evaluate all the losses of pregnant women (from abortions, ectopic pregnancy, obstetric and extragenital pathology during the entire period of gestation), women in labor and puerperas (within 42 days after termination of pregnancy).
In the International Classification of Diseases and Related Health Problems, 10th revision (1995), the definition of "maternal mortality" has not changed much compared to ICD-10.
maternal death defined as pregnancy-related (regardless of duration and location) death of a woman occurring during or within 42 days of pregnancy from any cause related to, aggravated by, or managed by the pregnancy, but not from accident or accident the cause that has arisen.
At the same time, a new concept has been introduced - “late maternal death”. The introduction of this new concept is due to the fact that there are cases of death of women that occurred later than 42 days after the termination of pregnancy from causes directly related to it and especially indirectly related to pregnancy (purulent-septic complications after intensive care, decompensation of cardiovascular pathology, etc.). d.). Accounting for these cases and analyzing the causes of death allows us to develop a system of measures to prevent them. In this regard, the 43rd World Health Assembly in 1990 adopted a recommendation that countries should consider including items relating to current pregnancy and pregnancy in the year preceding death on the death certificate and adopt the term "late maternal death.
Maternal deaths are divided into two groups: deaths directly attributable to obstetric causes: deaths due to obstetric complications, the state of pregnancy (i.e. pregnancy, childbirth and the puerperium), and those due to interventions, omissions, improper treatment or chain of events following any of the above reasons.
Death indirectly related to obstetric causes: death as a result of a pre-existing disease or a disease that developed during pregnancy, not due to a direct obstetric cause, but aggravated by the physiological effects of pregnancy.
Along with the indicated (main) causes, it is advisable to analyze the accidental causes of death (accidents, suicides) of pregnant women, women in childbirth and puerperas within 42 days after the completion of pregnancy.
The maternal mortality rate is expressed as the ratio of maternal deaths from direct and indirect causes to the number of live births (per 100,000).
Every year, more than 200 million women in the world become pregnant, which in 137.6 million ends in childbirth. Percentage of births in developing countries accounts for 86% of the number of births worldwide, and maternal mortality - 99% of all maternal deaths in the world.
The number of maternal deaths per 100,000 live births varies dramatically across parts of the world: Africa 870, South Asia 390, Latin America and Caribbean 190, Central America 140, North America 11, Europe 36, Eastern Europe 62, Northern Europe 11.
In economically developed countries low rates of maternal mortality due to high level development of the economy, sanitary culture of the population, low birth rate, high quality medical care women. In most of these countries, childbirth is carried out in large clinics equipped with modern diagnostic and treatment equipment and qualified medical personnel. The countries that have achieved the greatest success in protecting the health of women and children are characterized, firstly, by the full integration of the components of maternal and child health and family planning, the balance in their provision, financing and management, and secondly, the full availability of assistance in planning families within the health services. At the same time, the reduction in maternal mortality was mainly achieved through the improvement of the situation of women, the provision of maternal health and family planning within the framework of primary health care and the creation of a network of district hospitals and perinatal centers.
About 50 years ago, countries in the European Region for the first time formalized health care systems for pregnant women based on routine examinations and periodic visits to a doctor or midwife. With the advent of more sophisticated laboratory and electronic equipment, a large number of tests and changed the number of visits. Today, every country in the European Region has a legally established or recommended system of visits for pregnant women: for uncomplicated pregnancies, the number of visits varies from 4 to 30, averaging 12.
AT last years the strategy of the obstetric service was based on two principles: identifying pregnant women at high risk of perinatal pathology and ensuring continuity in the provision of obstetric care. Much of the attention paid to perinatal risk in the 1970s began to wane in the 1990s.
Another important feature of pregnancy care systems is the continuity of care. In Europe, the vast majority of systems consider pregnancy, childbirth and the postpartum period as three distinct clinical situations requiring a variety of clinical expertise, different medical staff and different clinical settings. Therefore, in almost all countries there is no continuity of care provided during pregnancy and childbirth, i.e., one specialist conducts a pregnant woman, and another, who has not previously observed her, conducts childbirth. Moreover, the change of personnel every 8 hours of work also does not ensure the continuity and succession of care during childbirth.
The Netherlands, a developed European country with a highly organized home delivery system (36%), has the lowest maternal and newborn mortality rates. Low-risk pregnancies and home births are monitored by a midwife and her assistant, who assists in the delivery and stays at home for 10 days to help the mother.
According to the WHO definition, maternal mortality refers to the death of a woman caused by pregnancy (regardless of its duration and location) and occurring during pregnancy or within 42 days after its termination from any cause associated with pregnancy, aggravated by it or its management, but not from an accident or an accidental cause.
This indicator allows you to evaluate all losses of pregnant women (from abortions, ectopic pregnancy, obstetric and extragenital pathology during the entire gestation period), as well as women in labor and puerperas within 42 days after the end of pregnancy. The concept of "maternal mortality" does not include cases of death as a result of murder, suicide, poisoning, trauma and other violent causes.
Maternal mortality rate:
the number of dead pregnant women (since the beginning of pregnancy), women in labor, puerperas within 42 days after termination of pregnancy? 100,000 / number of live births.
The maternal mortality rate should be calculated at the level of district, city, region, territory, republic. In the institution where the death occurred, a detailed analysis of each case (without calculating the indicator) of death should be carried out from the standpoint of its preventability.
When assessing the dynamics of maternal mortality in areas with low birth rates, in order to avoid errors, statistical methods should be used,
in particular, alignment of the dynamic series using the moving average method, which allows replacing each level of the series with the average value from the given level and two neighboring ones, eliminating the influence of random fluctuations on the level of the dynamic series and helps to identify the main trend.
An analysis of the structure of the causes of maternal mortality makes it possible to establish the place of one or another cause among all the dead women.
Structure of causes of maternal death:
number of women who died from this cause? 1000 / total number of women who died from all causes.
Of essential importance in the analysis of maternal mortality is the calculation of the frequency of death from individual causes.
Maternal mortality from individual causes:
number of women who died from a given cause? 100 / number of live births.
In the structure of the causes of maternal death, a large part (80%) is occupied by obstetric causes, and approximately 20% are occupied by causes associated with pregnancy and childbirth only indirectly (in particular, extragenital diseases).
Among obstetric causes, 70% belong to complications of pregnancy and childbirth, 25% to the consequences of abortion and 5% to ectopic pregnancy. Among extragenital diseases, diseases of the cardiovascular system predominate.
The high level of maternal mortality in the country is due to a number of reasons. In recent years, there has been an ever-increasing deterioration in the health of pregnant women, the rate of early coverage of their medical supervision, the quality of medical examinations of pregnant women are declining, and there is a high prevalence of abortions.
Infant mortality, its causes. Measures to reduce infant mortality.
Infant mortality - infant mortality in the first year of life (0-12 months). Infant mortality significantly exceeds mortality in all other age groups, with the exception of the elderly and senile age. Decreasing infant mortality contributes to an increase in the average life expectancy of the population.
The reasons:
In the structure of infant mortality aged 0 to 1 year in recent years 1st place occupy the state of the perinatal period (46% of all causes); 2nd place belongs to congenital anomalies (22%); 3rd place represented by respiratory diseases (14%); 4th place- infections (7%); 5th place occupy injury and poisoning (5-6%).
The significance of the same causes of death is different among stillborns who died in the early neonatal, late neonatal and postneonatal periods. If the stillborn have the most common cause death was intrauterine asphyxia (more than 73%), then in the early neonatal period these are birth injuries, intrauterine infections.
Among the causes of death in the neonatal period, diseases of the respiratory and gastrointestinal tract predominated. The proportion of these diseases as a cause of death increases even more in the postneonatal period.
Over the past decade, the infant mortality rate has decreased by 59.6 per cent. Such results were achieved due to the increase in the number of perinatal centers that treat children from birth to one year.
Often the reason for the death of children at an early age is the "lack of pediatric surgical care in the centers, the lack of specialists and special medical transport." Therefore, with the advent qualified assistance mortality among infants is reduced by 7.4‰ per 1000 live births.
Other reasons are the sex of the child, the age of the mother at the time of the birth of the child, the serial number of the birth and the size of the interval between these births and the previous ones (intergenetic interval).
Effect of maternal age on the level of infant mortality is expressed in the fact that the highest infant mortality is observed in very young (under 20 years old) mothers. The death rate of children born to women over 40 years of age increases slightly, but until the very end of the childbearing period, it does not reach the same level as in mothers under 20 years of age.
To a large extent, infant mortality is affected by birth number of the child. The mortality of the firstborn is higher than the mortality of subsequent children. The probability of death of subsequent children decreases with an increase in the serial number of birth up to the 7-8th child, after which it gradually increases, which can be explained by the physiological characteristics of older women.
The interval between two subsequent births -highest mortality observed among children born at intervals within a year after the previous birth. With an increase in the interval, the probability of death of subsequent children in the first year of life also decreases.
The most favorable interval between two births should be recognized as an interval of 2-3 years. A smaller interval causes a higher probability of death of a newborn, and a larger one will lead to the fact that children of high serial birth numbers will be born to older mothers, which is also not a completely favorable factor.
In this regard, one of the priority tasks for reducing infant mortality is the prevention of morbidity in children and, above all, the prevention of those diseases that are leading in the structure of not only morbidity, but also infant mortality.
Life expectancy
Rate of natural population growth
natural increase The population is considered as the difference between the birth rate and the death rate.
natural increase= (number of live births - number
population deaths in a given year) x 1000
average annual population
natural increase= birth rate - rate
population mortality
The rate of natural population growth is quite common characteristic population growth and does not always reflect demographic situation in society, since the same population growth rates can be obtained with various indicators fertility and mortality. In this connection natural increase should only be assessed in relation to birth and death rates. High natural increase can be considered as a favorable demographic phenomenon only with low mortality. A positive population growth with high mortality despite a relatively high birth rate characterizes an unfavorable type of population reproduction. The negative natural increase (population decline) observed in recent years, both in Russia and in the Sverdlovsk region, indicates a clear ill-being in society. This fact is called the unnatural population decline. Currently, the death rate of the population exceeds the birth rate by 1.6 times.
Life expectancy is an integral indicator for assessing public health and social well-being of society. Under indicator life expectancy should be understood as the hypothetical number of years that a given generation of births or the number of peers of a certain age will have to live, provided that throughout their life the mortality in each age group will be the same as it was in the year for which the calculation was made. This indicator
characterizes the viability of the population as a whole and does not depend on the characteristics age structure population. The indicator of life expectancy is calculated on the basis of age-specific mortality rates by constructing special tables of mortality (survival). They show the order of successive extinction of a population of persons born at the same time.
Life expectancy is one of the key indicators recommended by WHO as an indicator of the health and standard of living of the population of a particular region. In the national programs "Health for All" it is recommended to focus on the value of this indicator, equal to 75 years.
On average in Russia and the Sverdlovsk region, this indicator is significantly lower than recommended by WHO, especially for the male population. In the modern period, both in Russia and in the Sverdlovsk region, the difference between the expected life expectancy of women and men is on average 12 years. So, for example, in the Sverdlovsk region in 2004, the expected life expectancy of the female urban population corresponded to 70.79 years, while the male - 57.43 years, for residents countryside characteristics of this indicator are more unfavorable.
Maternal mortality is defined by the WHO as attributable to pregnancy, regardless of duration and location, the death of a woman during pregnancy or within 42 days after its termination, from any cause associated with pregnancy, aggravated by it or its management, but not from an accident. accident or accidental cause.
maternal mortality= number of women who died at the beginning
pregnancy, childbirth,
puerperas 42 days after
end of pregnancy x100000
number of live births
Maternal mortality refers to demographic indicators that refine the overall mortality rate. Due to its low level, it does not have a noticeable impact on the demographic situation, but at the same time it fully reflects the state of the system of maternal and child health in the region.
The dynamics of maternal mortality over several years, both in Russia and in the Sverdlovsk region, has a downward trend. However, compared with economically developed countries, the level of maternal mortality in our country is significantly higher (5-10 times).
Important in assessing the indicator of maternal mortality is the analysis of the causes of death - the frequency of death from individual causes and the percentage of individual causes of death. All maternal deaths are classified into 2 groups:
1. Death, directly related to obstetric causes, i.e. death as a result of obstetric complications, the state of pregnancy (pregnancy, childbirth and the postpartum period), as well as as a result of interventions, omissions, improper treatment and a chain of events arising from any other of the listed causes.
2. Death, indirectly related to obstetric causes, i.e. death as a result of a pre-existing disease, a disease that occurred during pregnancy, unrelated to
direct obstetric cause, but aggravated by the effects of pregnancy.
To assess the structural distribution of causes of maternal death, the following formula:
Cause structure= abs. number of women who died at the beginning
maternal mortality
42 days after graduation
pregnancy, from certain
reasons, for example, abortion x 100
abs. number of women who died at the beginning
pregnancy, childbirth, childbirth
42 days after graduation
pregnancy, from all causes
In the modern period, the following are leading in the structure of causes of maternal mortality in Russia and the Sverdlovsk region:
1. Bleeding during pregnancy and childbirth.
2. Abortions.
3. Pre-eclampsia and eclampsia.
4. Extragenital pathology (indirect cause of obstetric death).
It should be noted that in most foreign countries death from bleeding after abortion is reduced to zero.
Along with the indicator of maternal mortality, when conducting an in-depth analysis, an indicator such as late maternal mortality. Late maternal mortality is defined as the death of a woman from a direct obstetric cause or indirectly related to it, occurring more than 42 days after birth, but less than 1 year after birth. This indicator is not considered separately to characterize the medical and demographic situation.
The World Health Organization is concerned about the high rates of maternal mortality, because this indicator combines indicators of the health of women of reproductive age, indicators practical application new achievements of science in many branches, as well as many indicators of economic, medical-organizational, ecological and socio-hygienic nature.
The maternal mortality rate includes deaths after abortions (termination of pregnancy), as a result of ectopic pregnancies, as a result of various pathologies of pregnancy, including obstetric pathology or extragenital pathology, deaths during childbirth, and also during 42 calendar days after childbirth.
In addition, recently introduced medical practice the concept of "late maternal death", which includes fatal cases as a result of complications of a purulent-septic nature, as a result of cardiovascular problems and other pathological conditions that occurred later than 42 days after delivery.
All cases of maternal death should be carefully studied and analyzed. However, all such cases can be conditionally divided into two groups. The first group includes obstetric complications, as well as unsuccessful interventions, improper treatment, as well as deaths as a result of a disease that developed or worsened during pregnancy. The other group of maternal deaths includes only accidental causes of death, such as suicide and accidents, that occur to women in labor within six weeks of childbirth.
Attention! Maternal mortality (rate) is a measure of the ratio of maternal deaths from any cause to the number of live births (per 100,000).
Maternal mortality rates vary greatly by region.
For example, the highest number of maternal deaths per 100,000 live births occur in African countries (870 cases), in South Asia this figure is 390, in Central America - 140. Maternal mortality rates are somewhat lower in North America and Europe, although the figures are also here differ significantly. The lowest rates of maternal mortality are recorded in North America and Northern Europe - 11 cases per 100,000 live births, in Central and Southern Europe these figures are 36, but in Eastern Europe maternal mortality is the highest of all prosperous regions and is 62.
Researchers note that the low level of maternal mortality is directly related to a high standard of living, a high level of economic development and, as a result, a high level of sanitary culture of the population, with the quality of medical care, which is much higher in developed countries than in other regions.
In addition, the researchers note that the low level of maternal mortality is also influenced by the low birth rate in developed countries. It is also noted that in developed countries such areas of medicine as family planning, maternal and child health, the availability of necessary assistance in family planning, as well as sufficient funding for all programs related to childbearing are actively developing.
In the mid-70s of the twentieth century, the countries of Europe officially singled out a separate medical branch for the protection of the health of pregnant women. This system is based on special examinations, medical supervision, and conducting the necessary tests. If the pregnancy is proceeding normally, then the average number of visits to the doctor is 12, but can reach up to 30.
The lowest level of maternal mortality, as well as neonatal mortality, is noted in the Netherlands, where even births at home are often practiced, but with the obligatory presence of two medical workers and with an ambulance on duty near the house. The assistant midwife at home birth not only helps in the birth process, but also stays with the woman in labor for ten days to provide the necessary assistance.
Causes of maternal death
The leading causes of maternal death in developed countries such as the United States are as follows:
- Complications that began in the postpartum period — 33,8 %;
- — 16,9 %;
- Bleeding of various origins — 12,7 %;
- — 7%;
- Other causes of different origin and nature — 26,7 %.
With regard to the causes of maternal death in developing countries, the following play a special role:
- Low standard of living;
- Untrained birth attendants;
- Lack of access to the necessary modern medical care;
- Lack of necessary medical personnel in rural areas.
WHO has defined the structure of maternal mortality worldwide:
- More than 130,000 deaths are due to obstetric hemorrhages;
- About 130 thousand deaths as a result of sepsis;
- The cause of approximately 110 thousand deaths was eclampsia;
- About 80,000 deaths are due to abortions, uterine ruptures, embolisms;
- At least 80,000 more deaths are due to extragenital diseases.
Quite often cases of maternal deaths due to underlying diseases are recorded, the most frequent of which are the following:
- Hypertension, hypertensive conditions cause about 75 thousand maternal deaths per year;
- Anemia, thyroid disease, infectious diseases, and Sheehan's syndrome account for at least 50,000 more maternal deaths per year;
- Unfortunately, a considerable number of maternal deaths are also due to medical / medical errors - up to 50,000 proven cases per year.
The World Health Organization is confident that it is possible to reduce maternal mortality by improving the socio-economic situation; with a constant increase in the level of sanitary culture of the population in general and pregnant women in particular; with the further and continuous development of obstetric and gynecological care, especially in remote and rural areas.
conclusions
The World Health Organization continues to work constantly to reduce maternal mortality throughout the world, including in developing countries, and continues to develop measures to reduce such indicators, taking into account the economic and social development each region, as well as the level of medicine and possible medical assistance.
a) total fertility rate
b) fertility rate
c) total fertility rate
d) age-specific fertility rates
132. An indicator characterizing the levels of fertility and mortality,
currently existing in the territory
a) total fertility rate
b) gross - population reproduction rate
c) net - coefficient
133. The total fertility rate means
a) the average number of children a woman has
b) the average number of girls per woman
c) the average number of girls per woman
given the likelihood of her death
134.Reproduction in Russia in recent years is
a) simple
b) narrowed
c) extended
135.The value of the net coefficient for simple reproduction
population
136.
Compared to global fertility rates in Russia
in the last five years, this figure has been
b) below
c) equal to them
137.
What is the relationship between fertility rates and infant
mortality?
a) no connection
b) straight
c) reverse
138.
Compared to fertility rates in the developed world
in Russia this figure was
a) higher
c) at the same level
139.
Factors affecting the process of childbearing
impact on fertility
a) directly
b) indirect
140. The trend of the marriage rate in Russia over the past five years
a) decrease
c) stabilization
in recent years occurred in the following group of diseases
a) late toxicosis
c) cardiovascular disease
d) kidney disease
158. The share of repeated births in recent years in our country
a) increased
b) decreased
c) hasn't changed
159 . Dynamics of induced abortions in Russia over the past five years
a) decrease in the indicator
b) indicator growth
c) the indicator has not changed for several years
160. The share of criminal abortions in Russia is within
b) <10%
161 . The age at which a girl in Russia
has the right to independently decide on an abortion
a) from 1 8 years
b) from 15 years old
c) from the age of 20
162. Countries with very low abortion rates
a) Netherlands, Switzerland
b) France, England
c) Albania, Hungary
d) Bulgaria, Romania
163 . The concept of "family planning" most accurately reflects the following definition
a) a system of measures aimed at limiting the birth rate
b) ensuring control of reproductive function
for the birth of only desired children
c) methods that allow couples and individuals
avoid unwanted births
164. The most popular family planning method in Russia
a) hormonal therapy
c) induced abortion
d) sterilization
e) other methods of contraception
165 . Method of contraception prevailing in Russia
a) hormonal contraception
b) intrauterine contraception
a) sterilization
d) barrier methods
166
. Predominant contraceptive method
in most developed countries of the world
a) hormonal contraception
b) intrauterine contraception
c) sterilization
d) barrier methods
167. PLEASE MATCH
Artificial termination of pregnancy in Russia is performed
a) at the request of a woman 1) 12 weeks. a)
b) according to social indications 2) 22 weeks. b)
c) for medical reasons 3) any term c)
168. Sterilization in Russia can be done
a) at the written request of a citizen not younger than 35 years old
or having at least two children
b) at the request of a citizen aged at least 30 years
and having two children or older than 40
169. Medical Genetic Counseling (MGC)
from a health point of view,
a) a section of medical genetics that studies current general
and private problems of genetic counseling of families
with congenital and/or hereditary diseases (CHD)
b) a system for providing specialized medical genetic
assistance to the population of the region, including 3 main components
(1) neonatal screening, (2) proper medical genetic
counseling, (3) perinatal diagnosis of VNV in the fetus
c) communication process (transfer of genetic information
in a volume and at a level accessible to the understanding of families, in order to
developing an adequate solution for
further childbearing)
170 . Methods of perinatal diagnostics allow
a) unequivocally resolve the issue of the possibility of birth
sick child in pregnant risk groups
b) determine the risk of having a child with a hereditary pathology
