The problem of preserving reproductive health of pregnant women with placenta accreta and health of their newborns from the position of pharmacoeconomics

• Grigoriy A. Penzhoyan
• Tatyana B. Makukhina
• Milena A. Penzhoyan
• Vlada V. Pasyuga

Abstract

The aim of the study was to compare the frequency of obstetric complications and the costs of delivery of pregnant women with placenta accreta, to determine areas for improving the obstetric care system.

Material and methods. An analysis of official reports, information on form 32 of Rosstat for Krasnodar Region and State Budgetary Healthcare Institution “Krasnodar Clinical Hospital No. 2” for the period 2014–2023 and invoices for medical services, according to the Application to Program of State Guarantees for Free Provision of Medical Care to Citizens for 2024 was conducted.

Results. Using the example of the Perinatal Center of “RCH No. 2”, an increase in the frequency of clinically verified placenta accreta spectrum (PAS) in 2014–2023 was established by 5.3 times. It was determined that PAS is associated with a high frequency of premature births, massive blood loss and makes a major contribution to the structure of peripartum hysterectomies (HE). It has been established that neonatal morbidity in newborns from mothers with PAS is determined by prematurity, which entails in some cases the need for hardware prosthetics of the respiratory function, which increases treatment costs. The decrease in the incidence of HE in the Krasnodar Territory in 2015–2020 was due to the use of high-tech medical care (HTMC) with temporary endovascular reduction of blood flow in the common iliac arteries during childbirth, which significantly increased the cost of treating patients with PAS. The introduction of a system of early detection of pregnant women with a high risk of PAS with a differentiated choice of the timing and method of planned delivery in 2021–2022 made it possible to reduce the incidence of premature births among them by 2.5 times and reduce the incidence of obstetric HE in the Krasnodar Territory by 11.9% without additional material costs. The economic effect of individual choice of the time and method of delivery was determined by a reduction in the costs of nursing premature babies (p<0.05). The introduction of the strategy of early delivery of all pregnant women with PAS in 2023 was accompanied by an increase in the frequency of premature births among them (p<0.001), the costs of nursing premature babies (p<0.05), including with prosthetics of vital functions (p<0.05) without reducing the costs of childbirth and postpartum rehabilitation of mothers in terms of the frequency of use of HTMC (p>0.05), the frequency of hardware autohemotransfusions (p>0.05), in the absence of a significant reduction in the frequency of emergency and urgent deliveries (p>0.05).

Conclusion. Improving the quality of monitoring pregnant women at high risk of PAS and differentiated selection of the timing of planned delivery are most effective from the standpoint of pharmacoeconomics in preserving reproductive health of pregnant women with PAS and health of their newborns.

Keywords: placenta accreta; uterine hemorrhage; premature birth; peripartum hysterectomy; newborn; pharmaceutical economics

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