Obstetric hemorrhage as a cause of mother's mortality not occurred and occurred under the conditions of the megapolis

• Anton S. Olenev
• Yulia D. Vuchenovich
• Vladislavа A. Novikovа
• Victor E. Radzinsky

Abstract

The aim of this study: to differentiate the structure of the causes of obstetric hemorrhage in case of aborted and completed maternal mortality (MM) in the Russian metropolis.

Material and methods. Retrospectively, an analytical cohort study of 9 cases of MM and 77 cases of near miss due to obstetric bleeding that occurred in the Russian metropolis was conducted.

Results. The proportion of women with a gestational age of less than 22 weeks with MM is higher than with Near miss [OR=95 (95% CI 8.87-1017.103)]. Revealed a relationship between the history of cesarean (CS) and placenta previa [OR=26.92 (95% CI 8.48-85.45)], uterine scar failure (complete and incomplete rupture of the uterus, uterine aneurysm) [OR=3.44 (95% CI 1.35-8.82)] and abnormally invasive placenta (AIP) (χ²=59.2, p<0.001). Uterine aneurysm and AIP were diagnosed only with a scar on the uterus. Differences in the weight characteristics of women with MMS and Near miss are shown (χ²=28.27, p=0.00003).

Conclusion. Resource of the metropolis for the prevention of MM, causes of obstetric hemorrhage, highly effective, allows "near miss" for women with blood loss of up to 6000 ml (95.24 ml/kg). Rupture of aneurysms of the splenic artery as an indirect cause of MM, a rare cause of acute surgical pathology in obstetrics, remains a risk factor for MM. Ectopic pregnancy retains high risks for MM. Eclampsia in combination with placental abruption, requiring emergency CS, complicated by hypotonic bleeding, is a potentially fatal combination, even in a megalopolis. In MM iatrogenic factor not excluded.

Keywords:obstetric hemorrhage, maternal mortality, near miss, obstetric aggression, uterine scar after cesarean section, obesity

References

1. Radzinskiy V.E. Obstetric aggression, v. 2.0. Moscow: StatusPrae-sens, 2017: 872 p. (in Russian).

2. Filippi V., Chou D., Ronsmans C., Graham W., et al. Levels and Causes of Maternal Mortality and Morbidity. In: R.E. Black, R. Laxmina-rayan, M. Temmerman, N. Walker (eds). Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities. 3rd ed. Vol. 2. Washington, DC: The International Bank for Reconstruction and Development/The World Bank. 2016; Ch. 3.

3. Khorrami N., Stone J., Small M.J., Stringer E.M., et al. An overview of advances in global maternal health: From broad to specific improvements. Int J Gynaecol Obstet. 2019; 146 (1): 126-31. doi: 10.1002/ijgo.12841.

4. World Health Organization. Evaluating the quality of care for severe pregnancy complications The WHO near-miss approach for maternal health. 2011. URL: http://whqlibdoc.who.int/.../2011/9789241502221 .

5. Rocha Filho E.A., Costa M.L., Cecatti J.G., Parpinelli M.A., et al. Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study. Acta Obstet Gynecol Scand. 2015; 94: 50-8.

6. Surina M.N., Zelenina E.M., Artymuk N. Near miss and maternal mortality in the Kemerovo region. Mat' i ditya v Kuzbasse [Mother and Child in Kuzbass]. 2013; (1): 3-7. (in Russian)

7. World Health Organization, UNICEF, United Nations Population Fund and The World Bank. Trends in maternal mortality: 1990 to 2015. Geneva: WHO, 2015.

8. Padrul' M.M., Skryabina V.V., Berseneva S.N. Adverse maternal outcomes: analysis of the definitions and rates of maternal mortality and maternal near miss: what do the figures tell us? Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2018; (10): 12-9. URL: https://dx.doi.org/10.18565/aig.2018.10.12-19 . (in Russian).

9. Federal State Statistics Service. Maternal mortality. Updated 06.06.2019. URL: https://gks.ru/storage/mediabank/demo23.xls . (date of access November 5, 2019). (in Russian)

10. Audit of critical obstetric conditions in the Russian Federation in 2016. Methodical letter of the Ministry of Health of the Russian Federation. Moscow, 2017: 44 p. (in Russian).

11. Tskhai V.B., Shtokh E.A., Garibova G.Ch., Dudina A.Yu., et al. A rare case of postoperative uterine aneurysm after conservative myomectomy (demonstration of a clinical case. Sibirskoe meditsinskoe obozrenie [Siberian Medical Review]. 2016; (5): 65-73. (in Russian)

12. Visser G.H.A., Ayres-de-Campos D., Barnea E.R., et al. FIGO position paper: how to stop the caesarean section epidemic. Lancet. 2018; 392 (10 155): 1286-7. doi: 10.1016/S0140-6736(18)32113-5.

13. WHO. Statement on caesarean section rates. Geneva: World Health Organization, 2015. http://www.who.int/reproductivehealth/publi-cations/maternal_perinatal_health/cs-statement/en/ (date of access November, 2019).

14. Bashmakova N.V., Davydenko N.B., Malgina G.B. Maternal near-miss monitoring as part of a strategy for the improvement of obstetric care. Rossiyskiy vestnik akushera-ginecologa [Russian Bulletin of Obstetrician-Gynecologist]. 2019; 19 (3): 5-10. URL: https://doi.org/10.17116/ro-sakush2019190315 . (in Russian)

15. Radzinsky V.Ye., Logutova L.S., Krasnopolsky V.I. Caesarean section. Problems of abdominal obstetrics. V.I. Krasnopolskiy (ed.). Moscow: Spetsial'noe Izdatel'stvo Meditsinskikh Knig (SIMK), 2018: 224 p. (in Russian).

16. Lishchenko A.N., Anisimov S.N., Vartanyan S.M., Bochkareva I.V., et al. Spontaneous rupture of true splenic artery aneurysm in pregnant women. Vestnik khirurgii imeni I.I. Grekova [Bulletin of Surgery named after I.I. Grekov]. 2015; 174 (4): 84-6. (in Russian)

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