Social adverse pregnant women: the back side of the megapolis

• Anton S. Olenev
• Alexander G. Konoplyannikov
• Yulia D. Vuchenovich
• Arsen A. Ziyadinov
• Vladislavа A. Novikovа
• Victor E. Radzinsky

Abstract

The aim of the study - to assess the significance of social adverse in the risks near miss (NM) and maternal mortality (MM) in residents of the Moscow megalopolis.

Materials and methods. Performed a retrospective multicenter study (27 Moscow healthcare institutions; 2013-2018). Were analyzed 29 histories of socially adverse patients with life-threatening conditions leading to NM in 16 women, in 13 - to MM.

Results. No differences for NM and MM were found in age (p=0.6), BMI (p=0.68), place of residence (p=0.24), marital status (p=0.85). Characteristics of socially adverse pregnant of megalopolis: drug addiction - 43.75% for NM and 69.23% - for MM (p=0.32); HIV infection (93.75% and 61.54%, respectively, p=0.096); burdened reproductive history; lack of antenatal observation; severe non-obstetric diseases; weight loss during pregnancy more than 10%. Pregnancy less than 22 weeks increased the likelihood of MM (OR=5.06, 95% CI 0.96-26.67). The fatal significance of liver dysfunction in the outcome of life-threatening conditions that developed against the background of prolonged drug abuse, the use of psychoactive drugs, hepatitis of various genesis, etc., aggravated by gestational processes and its complications, was confirmed. A high proportion of low for gestation weight newborns was established - 84.62% for NM, 83.33% for MM, with extremely low body weight - 15.38% and 33.33% respectively.

Conclusion. The resource of the megalopolis allows preventing MM of women with extremely severe morbidity and social adverse, but it is not unlimited. The flip side of the metropolis - drug addiction, HIV infection, tuberculosis, lack of a permanent place of residence, unplanned pregnancy antenatal without follow-up (84.62%), development of life-threatening conditions during pregnancy 23 weeks or less - exclude prevention, timely diagnosis potentially irreversible organ, functional disorders limit the ability to prevent MM. Effective social work is needed, treatment of severe non-obstetric diseases.

Keywords:life-threatening conditions, near miss, maternal mortality, social adverse, drug abuse, HIV, pregnancy, multiple organ failure

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