Social adverse pregnant women: the back side of the megapolis
AbstractThe 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
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Olenev A.S., Konoplyannikov A.G., Vuchenovich Yu.D., Ziyadinov A.A., Novikova V.A., Radzinsky V.E. Social adverse pregnant women: the back side of the megapolis Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2020; 8 (3): 8-15. DOI: 10.24411/2303-9698-2020-13001 (in Russian)
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