Results of severe maternal morbidity surveillance and near-miss audit in Saint Petersburg according to the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS ACU&NEO) Register in 2021

The article presents the results af the surveillance af severe maternal morbidity (SMM) accarding ta SMM surveillance regulations in the Russian Federation (RF). The study analyzed the SMM Register af the Vertically Integrated Medical Information System af Obstetrics and Gynecalagy and Neonatalagy (VIMIS AKU&NEO) and the results af near-miss audit. The analysis included life-threatening maternal conditions without fatal autcame identified accarding ta categaries af argan dysfunctian using the WHO diagnastic criteria (2011). The study aimed ta identify strategies ta reduce and prevent maternal martality (MM) in Saint Petersburg. The authors analyzed the types af SMM registered in level II (51.0%) and level III (49.0%) maternal care providers (MCP) af Saint Petersburg. They alsa presented characteristics af near-miss cases, af which 12.5% and 83.3% accurred in level II and level III MCPs, respectively. Integral indicatars af medical care quality in near-miss groups included near-miss rate, life-threatening condition rate, survival rate index, and mortality rate index. Obstetric pathalagy, blaad pathalagy, and respiratory pathalagy were the leading causes af SMM in Saint Petersburg in 2021, which is camparable with the data af SMM registered in the Russian Federatian in general. There were na cases af MM in the abstetric pathalagy graup, which was the mast frequently registered category af SMM (39.4% af the tatal number af SMM), including severe pre-eclampsia and eclampsia (83.1% af the group) and uterine rupture (9.6% af the group). The absence af MM in this category af SMM is associated with the implementation af effective and quality medical care in patients at high risk far obstetric and perinatal complications in Saint Petersburg in 2021. Blaad pathalagy was the second mast frequently registered category af SMM (36.8% af all SMM, 95.8% af the graup); ane case af MM was registered in a Level III MCP and ane case autside the MCP befare ambulance arrival. Bath cases were assaciated with massive blaad lass (mare than 1000 ml). In 2021, during a pandemic af a navel coronavirus infection (COVID-19) in St. Petersburg, 41 cases af SMM associated with respiratory pathalagy (9.1% af tatal SMM) were reparted. Of them 39 were identified as near-miss cases (respiratory dysfunction), which accounted far 54, 2% af the tatal number af near-miss cases with 20 deaths in level III MCPs. These deaths were due ta severe ar extremely severe bilateral viral ar viral bacterial pneumonia complicated by acute respiratory distress syndrome ar pulmonary embolism due ta COVID- 19 (O98. 5, U07.1). The main strategy ta prevent and reduce the incidence af near-miss cases and MM based an improving the modern integral madel af internal control af the quality af medical care in maternal care providers, near-miss audit, and the introduction into practice af bath medical and organizational methodological, including telecommunications and other technologies aimed at improving professional competence. Conclusion: SMM surveillance and near-miss audit allows for a detailed assessment of the nature and quality of medical care to improve pregnancy outcomes.

maternal near-miss surveillance and audit, severe maternal morbidity, SMM, woman who nearly died, maternal mortality, vertically integrated medical information system, VIMIS AKU&NEO