Ways of maternal mortality risk reduction in critical obstetric conditions

• Nariman R. Akhmadeev
• Ildar F. Fatkullin
• Aliya I. Nurmukhametova
• Bella V. Panteleeva

Abstract

Critical obstetric conditions can be fatal.

The aim of the study was to determine ways of maternal mortality risk reduction in patients with critical obstetric conditions including those associated with great obstetric syndromes (GOS).

Material and methods. The retrospective observational selective study was conducted. 2508 clinical cases were analyzed, including subgroups with the exclusion of COVID-19 cases, and a subgroup with GOS.

Results. The risks of maternal mortality are reduced with proper routing to the 3A group obstetric hospitals [by 5.485 times (p=0.026); 17.784 times (p<0.001), 126.596 times (p=0.001), respectively in the whole group, group of COVID-19 exclusion, group of GOS], secondary obstetric hospitals [no effect in the whole group; in 5.743 times (p=0.022), 45.000 times (p<0.001)]. Delay in informing the regional consulting center increases the risk of maternal death by 0.7–1.0% per day (p<0.001). The condition, assessed in the supervising consultation center, as not requiring consultation with the federal center, reduced the risk of maternal death by 3.430 times (p<0.001) for patients with COVID-19, and by 2.745 times (p=0.030) for patients with extragenital pathology. No such correlation was found for cases of GOS.

Conclusion. Timely correct routing of patients with critical obstetric conditions will reduce the risk of maternal mortality, and identifying a group of patients with GOS will allow them to be rationally routed to obstetric hospitals of the 2^nd group without increasing the risk of maternal mortality even in cases of critical obstetric conditions.

Keywords:critical obstetric conditions; great obstetric syndromes; maternal mortality; critical obstetric conditions; obstetric hospitals

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