Maternal mortality in the Far Eastern Federal District during the pre-epidemic period and three years of the Covid-19 pandemic
- Authors: Belokrinitskaya T.E.1, Shmakov R.G.2, Frolova N.I.1, Brum O.Y.3, Krivoshchekova N.A.4, Pavlova T.Y.5, Rinchindorzhiyeva M.P.6
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Affiliations:
- Chita State Medical Academy, Ministry of Health of Russia
- Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
- Transbaikal Regional Perinatal Centre, Ministry of Health of Russia
- Blagoveshchenskaya City Clinical Hospital, Ministry of Health of Russia
- Perinatal Center of the Republic of Sakha (Yakutia) "Republican Hospital No. 1 of the National Center of Medicine"
- Buryat Republic Perinatal Center
- Issue: No 11 (2023)
- Pages: 87-95
- Section: Original Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/626108
- DOI: https://doi.org/10.18565/aig.2023.160
- ID: 626108
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Abstract
Objective: This study aimed to evaluate the structure and indicators of maternal mortality (MM) in the Far Eastern Federal District (FEFD) during the pre-epidemic period and the first three years of the novel coronavirus infection (NCI) pandemic.
Materials and methods: A retrospective comparative analysis of the dynamics of the MM indicators and structure in FEFD for the years 2019–2022 was conducted. A statistical database was generated from the emergency notification cards of the MM cases. In all cases of maternal loss from COVID-19, SARS-CoV-2 was identified by PCR in the nasopharyngeal material.
Results: The dynamics of the MM rate in FEFD during the reported period showed trends similar to those of the all-Russian rate. However, the MM rate exceeded the all-Russian rate by 18.9‰ (RF 9.8‰) in 2019, by 22.4‰ (RF 16.3‰) in 2020, by 45.3‰ (RF 42.4‰) in 2021, and by 23.2‰ (RF 12.6‰) in 2022. In the pre-epidemic year 2019, obstetric causes accounted for the largest proportion (82.4%), whereas the proportion of extragenital diseases (EGD) was significantly lower at 17.6% (χ2=11.8; p<0.001). In the first year of the COVID-19 pandemic (2020), MM increased owing to a significant increase in EGD mortality from 17.6% in 2019 to 75.0% (χ2=9.9; p=0.002), of which NCI accounted for a large proportion (40.0%). Maternal mortality from non-communicable diseases increased 2.0-fold: 17.6% (2019) vs. 35.0% (2020), indicating organizational challenges in the care of patients with EGD. The proportion of obstetric causes of MM decreased from 82.4% to 25.0% (χ2=9.9, p=0.002). In the second year of the epidemic, there was a 2.0-fold increase in MM due to a multiple of COVID-19 maternal losses: 66.6% (2021) vs. 40.0% (2020) (χ2=3.9; p=0.050), driven by the greater pathogenicity of the delta strain. The proportion of obstetric causes of MM did not change significantly: 20.5% (2021) vs. 25.0% (2020), p=0.951, but there was a 1.5-fold increase in the number of female villagers (43.6% vs. 30%). In the third year of the pandemic, EGDs remained the leading cause of MM, with no significant change in their proportion: 68.4% (2022) vs. 66.6% (2021), p=0.870. Notably, there was a significant decrease in the proportion of MM cases from the NCI (15.7 % (2022) vs. 66.6 % (2021), p<0.001), while there was a significant increase in the number of losses from severe non-infectious EGD. None of these pregnant and postpartum women had been examined by a specialist prior to pregnancy and had received no pre-pregnancy care. There was late seeking of medical attention and, in some cases, underestimation of severity and clinical symptoms in primary health care settings and by allied specialists.
Conclusion: The dynamics and structure of MM in FEFD, as revealed in this study, underscore the need for management decisions aimed at improving the current system of medical examination of fertile-age patients and routing of pregnant women who are at risk of developing critical obstetric conditions.
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About the authors
Tatiana E. Belokrinitskaya
Chita State Medical Academy, Ministry of Health of Russia
Author for correspondence.
Email: tanbell24@mail.ru
ORCID iD: 0000-0002-5447-4223
Dr. Med. Sci., Professor, Head of the Obstetrics and Gynecology Department of the Pediatric Faculty and Faculty of Professional Retraining
Russian Federation, 672000, Russia, Chita, Gorky str., 39aRoman G. Shmakov
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia
Email: r_shmakov@oparina4.ru
ORCID iD: 0000-0002-2206-1002
Dr. Med. Sci., Professor of the RAS, Head of the Institute of Obstetrics
Russian Federation, 117997, Moscow, Oparin str., 4Nataly I. Frolova
Chita State Medical Academy, Ministry of Health of Russia
Email: tanbell24@mail.ru
ORCID iD: 0000-0002-7433-6012
Dr. Med. Sci., Associate Professor at the Department of Obstetrics and Gynecology of the Pediatric Faculty and Faculty of Professional Retraining
Russian Federation, 672000, Chita, Gorky str., 39aOlga Yu. Brum
Transbaikal Regional Perinatal Centre, Ministry of Health of Russia
Email: ymnenkaya@yandex.ru
ORCID iD: 0000-0002-6065-3666
Deputy Chief Physician for Obstetrics and Gynecological Care
Russian Federation, 672090, Chita, Kokhansky str., 16Natalia A. Krivoshchekova
Blagoveshchenskaya City Clinical Hospital, Ministry of Health of Russia
Email: zamrod_gkb1@mail.ru
ORCID iD: 0000-0001-9345-1553
Deputy Chief Physician for Obstetrics and Gynecology
Russian Federation, 675000, Amur region, Blagoveshchensk, Gorky str., 247Tatiana Yu. Pavlova
Perinatal Center of the Republic of Sakha (Yakutia) "Republican Hospital No. 1 of the National Center of Medicine"
Email: tatyanaupavl@mail.ru
ORCID iD: 0000-0002-3319-912X
PhD, Director, Perinatal Center of the Republic of Sakha (Yakutia) Republican Hospital No. 1 of the National Center of Medicine
Russian Federation, 677010, Republic of Sakha (Yakutia), Yakutsk, Sergelyakhskoe highway, 4Marina P. Rinchindorzhiyeva
Buryat Republic Perinatal Center
Email: marirmp@mail.ru
ORCID iD: 0000-0003-1153-6057
PhD, Head of the Organizational and Methodological Unit
Russian Federation, 670047, Ulan-Ude, Pirogova str., 15BReferences
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