WAYS OF REDUCING OBSTETRIC LOSSES

Materials and methods. Two hundred and twenty-eight cases that had nearly ended in death from severe obstetric complications in pregnant women, parturients, and puerperas and 74 maternal death cases were analyzed. A comprehensive analysis of maternal deaths, assessment of perinatal risk factors, study of a correlation of signs, and statistical data processing were made. Results. Analysis of the defects at the stages of medical care revealed substantial differences for the women who had and nearly died: in the former, the defects per patient were 1.5-fold greater than those in the latter (the errors in assessing risk factors were 0.922±0.017 and 0.733±0.12; the defects of diagnostic and therapeutic measures, 0.894±0.023 and 0.666±0.11; low specialist training level, 0.892±0.023 and 0.616±0.090; inadequate level of obstetric services, 0.844±0.035 and 0.583±0.096). In-depth clinical analysis of critical obstetric complications suggests the definition of nearly dead female cases and provides evidence that it is necessary to calculate the index similar to that of maternal mortality (per 100000 live births) in a specific region. Conclusion. Thorough clinical analysis of nearly dead cases is a weighty contribution to the further reduction of maternal mortality rates, which is borne out by the equitype defects of a therapeutic and diagnostic process, which lead to fatal outcome in cases of preventable maternal death and its high risk in nearly dead women. Better conditions for maintaining maternal health should be aimed at reducing the number of fatal outcomes and be achieved by decreasing that of nearly dead female cases with a prior obstetric catastrophe.

maternal mortality, critical obstetric conditions, clinical audit