Characteristics of obstetric care in Ukraine

Abstract

In modern conditions of an unfavorable demographic situation, prolonged hostilities in the East of Ukraine, the transformation of the health sector, the unsatisfactory state of health of the population, obstetrics, as an important tool for the formation of public health, has a particular social and political significance. Purpose — to carry out a comprehensive analysis and assessment of the effectiveness of obstetric care in Ukraine in the modern period. Materials and methods. A comprehensive retrospective analysis and assessment of the dynamics of the main indicators of obstetric care in Ukraine based on the data of state and industry statistics for the period 2001–2019 was carried out. Methods of a systematic approach, bibliographic, statistical data processing, graphic representation are applied. Results. The data of the study showed that the current system of obstetric care is based on the principles of evidence-based practice and evidence-based management. Conducted at the population level, a continuous study of changes in the indicators of the organization of obstetric care at the pre-hospital stage showed a decrease in the number of abortions from 27.0 per 1000 women of fertile age in 2001 to 7.5 in 2019, OR from 95% CI 0.26 (0.26–0.27), full coverage of pregnant women with ultrasound, testing for syphilis, the presence of HIV/AIDS with still insufficient provision of pregnant women with early dispensary observation — 91.96–90.25%, high, with a positive trend, the frequency of gestosis — 11, 3 per 100 pregnant women in 2001 and 6.57 in 2019, the rate of decline is 71.9%, pre_eclampsia and eclampsia are 2.8% in 2001 and 2.11% in 2019, the rate of decline is 24.6%. It has been proved that the organization of obstetric and neonatal care based on the developed protocols, which are based on evidence-based medicine data, made it possible to ensure a positive dynamics of complicated labor from 67.8% in 2001 to 36.23% in 2019, OR with 95% CI 0.26 (0.26–0.27), labor anomalies from 111.2 to 41.14 per 1000 births, OR with 95% CI 0.3 (0.3–0.4), obstetric bleeding from 36,3 to 18.55, OR with 95% CI 0.5 (0.49 0.53). Issues of increasing the volume of surgical interventions in childbirth remain problematic — the frequency of cesarean sections from 114.99‰ to 253.1‰, OR from 95% CI 2.4 (2.3–2.4), instrumental vaginal delivery — from 5.27‰ up to 13.8‰, OR with 95% CI 2.6 (2.5–2.8). The level of maternal mortality remains high, despite the positive dynamics (23.9 per 100 thousand live births in 2001 and 14.9 in 2019). The registered decrease in reproductive losses from 9.1‰ in 2001 up to 8.8‰ in 2019 was accompanied by an unfavorable change in the structure of perinatal mortality — an increase in stillbirth from 4.8‰ to 5.8‰, OR from 95% CI 1.2 (1.1–1.3) against the background of a persistent increase in the part of antenatal fetal death — from 85.3% in the structure of stillbirth in 2001 to 90.5% in 2019 with a decrease in postnatal mortality from 4.3‰ to 3.0‰, OR from 95% CI 0.7 (0.6–0.8). Conclusions. The reserves for further improvement of the system of providing medical care to pregnant women. to women in labor, postpartum women and newborns is the further development and implementation of medical organizational technologies, which are based on evidence, the organization of monitoring indicators of the organization of obstetric care, its quality and availability. No conflict of interest was declared by the authors. Key words: obstetrics perinatology, pregnancy, childbirth, newborns, perinatal mortality, stillbirth, maternal mortality.