At first glance, even the very term “maternal mortality” is strange to hear in our time, the era of modern medical technology, the widespread development of the possibilities of reproductive medicine. At the same time, physicians define maternal mortality as the death of a woman during pregnancy or within 42 days after its completion. Despite a clear downward trend, over the past 20 years, maternal mortality in Russia and in the world as a whole has remained quite high.
Let’s turn to the data of the World Health Organization. About 830 women die every day from preventable causes related to pregnancy and childbirth. And 99% of all maternal deaths occur in developing countries. About 350,000 maternal deaths are registered annually in the world, and this figure, by the way, is equal to the population of the city of Sochi. Moreover, women living in large cities and regional centers have a higher chance of a successful delivery – the highest rates of maternal mortality are observed among women living in rural areas and among poorer communities. An estimated 303,000 women died during and after pregnancy and childbirth in 2015. Therefore, today the efforts of the medical community are focused on significantly reducing the global maternal mortality rate to less than 70 per 100,000 live births.
In Russia, according to the Ministry of Health of the Russian Federation, year after year there is a systematic decrease in maternal and infant mortality rates. For example, in 2017, maternal mortality decreased by 27% compared to the previous year. In numerical terms, this is 7.3 cases per 100 thousand births. For comparison, in 1990 this figure was 6.5 times higher – 47.7 cases per 100,000 births. But, as doctors say, it’s too early to celebrate a victory if at least one such case a year takes place. In 2018, 149 Russian women died from the consequences of childbirth. If someone thinks that this is not enough, imagine that one of your relatives, acquaintances, colleagues, friends could be in the place of each of them. Each such death is a great grief for the family, the born child, who remains an orphan for life. But it should also be noted that the maternal mortality rate in our country is also declining and is approaching that in developed countries.
Leading causes of maternal death
There are several reasons for maternal death. Let’s name the main ones. First of all, the unfavorable outcome of childbirth may be due to the fact that there are still such diseases in obstetrics, the causes and mechanism of development of which have not been fully studied, which means that it is impossible to prevent them in 100% of cases. First of all, this extragenital pathology – this includes chronic diseases of the mother that existed before pregnancy and complicate it, or diseases that first aggravated during pregnancy.
There are extragenital diseases that are insignificant for pregnancy, which to a small extent affect the course of gestation (the number of full weeks of gestation that have passed from the date of the first day of the last menstruation to the birth of a child) and do not pose a threat to life for the mother and fetus: chronic gastritis, chronic cystitis , osteochondrosis, etc.
There is also a more formidable group of somatic (extragenital) pathologies, which can significantly complicate the course of gestation, childbirth and the postpartum period and increase the risk of adverse outcomes, up to death (cardiovascular insufficiency, and in particular heart attacks, brain diseases – strokes, brain cysts). brain, diseases of the liver, kidneys, leading to a decrease in their function, etc.).
Provoke an unfavorable outcome of childbirth can alsobleeding due to various reasons:premature detachment of the placenta (during pregnancy and childbirth), impaired uterine contractility in the early postpartum period (atony and hypotension), traumatic injuries during childbirth (rupture of the uterus and soft birth canal), as well as congenital or acquired pathology of the blood coagulation system ( genetic thrombophilia, von Willebrand disease, etc.).
It is worth noting that obstetric bleeding is characterized by massiveness and lightning speed of blood loss, so if qualified assistance is not provided in a matter of minutes in this situation, the woman will die. Therefore, in this situation, the experience and qualifications of the doctor taking delivery are important in order to promptly take measures to save the woman in case of possible complications.
The third group of pathologies that can cause maternal death is preeclampsia, eclampsia.which are severe stages of preeclampsia, or in other terminology, late toxicosis, is characterized by dysfunction of vital organs.
Preeclampsia is a preconvulsive critical condition of a woman in labor, which is characterized by a significant rise in blood pressure, a high protein content in the urine, and is most often accompanied by severe edema. This is the most severe complication of the second half of pregnancy or the postpartum period, ultimately leading to multiple organ failure (failure of several organs at once). According to the severity, moderate and severe preeclampsia are distinguished. If with moderate preeclampsia it is possible to prolong pregnancy for a certain period (under the control of the condition of the mother and fetus), then severe preeclampsia is a life-threatening condition and an indication for emergency delivery.
Also, the adoption of urgent rescue measures requires the state of eclampsia – this is a convulsive attack, which either can be removed, or it goes into a coma. There are cerebral, comatose, hepatic and renal eclampsia.