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Comparative data on the number of cases and the rate of maternal mortality in the Russian Federation are presented. The analysis of indicators, structure and causes of mortality in the Russian Federation in 2020 during the COVID-19 pandemic. A set of measures has been proposed to prevent and reduce maternal mortality. Particular attention was paid to the implementation of modern approaches to the training of medical workers, including the training in simulation centers as part of the implementation of the federal project “Development of children’s healthcare, including the creation of a modern infrastructure for the provision of medical care for children” of the national project “Health”. © 2022, Media Sphera Publishing Group. All rights reserved.
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The article presents the results of the surveillance of severe maternal morbidity (SMM) according to SMM surveillance regulations in the Russian Federation (RF). The study analyzed the SMM Register of the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS AKU&NEO) and the results of near-miss audit. The analysis included life-threatening maternal conditions without fatal outcome identified according to categories of organ dysfunction using the WHO diagnostic criteria (2011). The study aimed to identify strategies to reduce and prevent maternal mortality (MM) in Saint Petersburg. The authors analyzed the types of SMM registered in level II (51.0%) and level III (49.0%) maternal care providers (MCP) of Saint Petersburg. They also presented characteristics of near-miss cases, of which 12.5% and 83.3% occurred in level II and level III MCPs, respectively. Integral indicators of medical care quality in near-miss groups included near-miss rate, life-threatening condition rate, survival rate index, and mortality rate index. Obstetric pathology, blood pathology, and respiratory pathology were the leading causes of SMM in Saint Petersburg in 2021, which is comparable with the data of SMM registered in the Russian Federation in general. There were no cases of MM in the obstetric pathology group, which was the most frequently registered category of SMM (39.4% of the total number of SMM), including severe pre-eclampsia and eclampsia (83.1% of the group) and uterine rupture (9.6% of the group). The absence of MM in this category of SMM is associated with the implementation of effective and quality medical care in patients at high risk for obstetric and perinatal complications in Saint Petersburg in 2021. Blood pathology was the second most frequently registered category of SMM (36.8% of all SMM, 95.8% of the group);one case of MM was registered in a Level III MCP and one case outside the MCP before ambulance arrival. Both cases were associated with massive blood loss (more than 1000 ml). In 2021, during a pandemic of a novel coronavirus infection (COVID-19) in St. Petersburg, 41 cases of SMM associated with respiratory pathology (9.1% of total SMM) were reported. Of them 39 were identified as near-miss cases (respiratory dysfunction), which accounted for 54, 2% of the total number of near-miss cases with 20 deaths in level III MCPs. These deaths were due to severe or extremely severe bilateral viral or viral bacterial pneumonia complicated by acute respiratory distress syndrome or pulmonary embolism due to COVID-19 (O98. 5, U07.1). The main strategy to prevent and reduce the incidence of near-miss cases and MM based on improving the modern integral model of internal control of the quality of medical care in maternal care providers, near-miss audit, and the introduction into practice of both medical and organizational methodological, including telecommunications and other technologies aimed at improving professional competence. Conclusion: SMM surveillance and near-miss audit allows for a detailed assessment of the nature and quality of medical care to improve pregnancy outcomes.
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Objective: To assess the morbidity, clinical course, maternal and perinatal outcomes of the new coronavirus infection COVID-19 in pregnant women in the Far Eastern and Siberian Federal Districts based on the results of 2020–2021. Materials and methods: The latest information on COVID-19 in pregnant women, women in labor and women who recently gave birth was analyzed. The findings were presented by the chief obstetricians-gynecologists of the regions in the period from March 11, 2020 to December 25, 2021. Results: A total of 27,210 cases of COVID-19 in pregnant, parturient and puerperal women were registered during the 2-year pandemic. The morbidity rate in these women was 2.4 times higher compared to the general population: 18988.0 vs 8019.5 per 100,000 people. SARS-CoV-2 infection was asymptomatic in 24.2% of mothers;it was mild in 50.0%, moderate in 21.3%, severe in 3.7%, and extremely severe in 0.8%. Pregnant women were more often hospitalized and stayed in intensive care and anesthesiology units compared to patients in the general population (5.5% vs 1.9%, p<0.001), and invasive mechanical ventilation (IMV) was used less often (0.7% vs 1.4%, p<0.05). There were 6,416 (23.6%) patients who gave birth to 6,512 children. Preterm delivery was in 18.5% (6.1% in Russia);cesarean sections – 38.8% (30.1% in Russia);operative vaginal delivery – 0.3% (0.13% in Russia). There were 81 (0.3%) deaths among mothers with COVID-19 (2.5% of cases among the population, p<0.001). Perinatal losses were registered in 156 cases (2.4%): stillbirths – 141 (2.17%), early neonatal mortality – 15 (0.23%). COVID-19(+) was revealed in 165 (2.5%) newborns. Conclusion: The incidence of COVID-19 in pregnant women was significantly higher than in general population during the 2-year pandemic, but the disease is characterized by more frequent hospitalization to intensive care and anesthesiology units, by lower demand for IMV and lower mortality rate. The second year of the pandemic was characterized by a more unfavorable course of COVID-19 in mothers and by an increase in the severe forms of the disease and indicators of maternal and perinatal mortality. The rates of preterm delivery and cesarean section in patients with COVID-19 were higher than in the general population. The incidence of SARS-CoV-2 virus isolation in newborns decreased significantly (from 6.2 to 2.5%). Further studies in this area are necessary. The morbidity rate of COVID-19 in pregnant women in Siberia and the Far East is higher than in the general population, but the disease is characterized by a lower need for IMV and a lower mortality rate. The rates of preterm birth and cesarean section are higher in patients with COVID-19 than in the general population. Finding of the SARS-CoV-2 RNA in newborns suggests vertical transmission of the infection. © A group of authors, 2022.
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Objective. To provide a comparative assessment of comorbid factors and the clinical course of the COVID-19 in pregnant women who died and survived a critical condition (near miss) in the Siberian and Far Eastern Federal Districts of Russia. Material and methods. Design was a retrospective study. The analysis of the primary medical documentation of pregnant women and postpartum women with a severe course of COVID-19 from April 1, 2020 to May 25, 2021 was carried out. Mathematical analysis included methods of descriptive statistics, analysis of contingency tables, where the value of χ2 was estimated, the achieved level of significance (p);calculation of the odds ratio (OR) at a 95% confidence interval (95% CI). Results. 10.842 cases of COVID-19 of pregnant women were registered in the Far Eastern Federal District and the Siberian Federal District. The incidence rate in pregnant women was 2.7 times higher than among the general population: 8833.5 vs. 3289.1 per 100 thousand population (8.8% vs. 3.2%;p<0.001). The proportion of deaths in pregnant women, women in labor and parturient women was 0.19%, among the population — 2.3% (p<0.001). The highest risk of maternal mortality (MM) is associated with obesity (OR=80.3;95% CI 9.34-690.19), slightly lower — with diabetes (OR=11.3;95% CI 2.0-63.27);chronic arterial hypertension (OR=17.2;95% CI 1.80-163.62);respiratory diseases (OR=12.2;95% CI 1.19-123.96);anemia (OR=4.5;95% CI 1.28-16.02). CT grade 3-4 lung damage on admission was associated with a 9-fold increase in the risk of death (OR=9.1;95% CI 3.03-27.14). The risk factors for MM were delay of antibacterial (OR=4.6;95% CI 11.24-16.87) and glucocorticoid (OR=3.4;95% CI 1.24-9.16) therapy. Anticoagulant therapy was prescribed statistically significantly later in the MM group (5.3±1.2 vs. 3.5±1.1;p=0.048). Conclusion. The risk of maternal mortality in COVID-19 is associated with co-morbid factors — obesity, diabetes, chronic arterial hypertension, respiratory diseases, and anemia, delay of antibacterial and glucocorticoid therapy. Timely anticoagulant therapy and delivery are key factors to preventing maternal mortality. Cesarean section for obstetric indications does not increase the risk of poor outcome, while operative delivery with intractable respiratory failure and refractory septic shock is associated with a high risk of maternal death. © 2021, Media Sphera Publishing Group. All rights reserved.
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Presented are two clinical cases of pregnancy, childbirth and the postpartum period in patients with a new coronavirus infection COVID-19 of the obstetric department of the Filatov City Clinical Hospital No.15. Despite the severe course of the disease, an extremely high risk of fatal complications, thanks to clear routing, a multidisciplinary approach and effective treatment tactics, it was possible to successfully solve the most difficult medical and diagnostic problems, save the lives and preserve the health of patients and newborns. © 2021, Media Sphera Publishing Group. All rights reserved.
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This review provides current information on safety and effectiveness of COVID-19 vaccines for pregnant and lactating patients. Various vaccine types, information regarding reproductive toxicology studies and vaccines efficacy against variants of concern are described in the article. The review also reflects practice guidelines of international professional communities on the use of COVID-19 vaccines in pregnancy, including the World Health Organization, RCOG (Royal College of Obstetricians and Gynecologists), ACOG (American College of Obstetricians and Gynecologists), RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists), etc. Currently, there is no evidence of a negative impact of COVID-19 vaccines on male and women’s reproductive health. On the other hand, the negative consequences of COVID-19 infection are well known both on the reproductive health of men and on the course and outcomes of pregnancy. Results of analysis of data on the course of pregnancy, childbirth, the postpartum period and the condition of newborns in 891 patients with coronavirus infection and in 1694 patients without coronavirus infection of the obstetric department of the Filatov City Clinical Hospital No. 15 for the period from January 1, 2020 to April 25, 2021. It was revealed that patients with coronavirus infection have a higher risk of preterm birth, a higher probability of having premature babies, and a higher percentage of operative delivery, than in patients without coronavirus infection. Newborn children in patients with coronavirus infection were more often admitted to the intensive care unit, than children of patients without coronavirus infection. Patients with coronavirus infection have a higher perinatal mortality rate than patients without coronavirus infection. No data has been received to support vertical transmission of the virus from a mother infected with COVID-19 to her fetus. There were no specific changes in placental tissue in patients with coronavirus infection. Based on the available results of clinical studies on the safety and efficacy of COVID-19 vaccines, all mentioned professional communities (WHO, CDC, ACOG, RCOG, RANZCOG, etc.) strongly recommend getting COVID-19 vaccine for women who are pregnant or breastfeeding. © 2021, Media Sphera Publishing Group. All rights reserved.
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Aim. To assess the incidence, clinical course, outcomes of a novel coronavirus infection (NKI) COVID-19 for mother and child in the population of pregnant women in the Far Eastern (FEFD) and Siberian Federal Districts (SFD). Materials and methods. The study design: a population-based epidemiological prospective study. We analyzed operative information on NKI COVID-19 incidence and features of clinical course in pregnant women, women in labor and parturient women as well as maternal and perinatal outcomes for March 11 to December 25, 2020 which were provided by the FEFD and SFD chief obstetricians-gynecologists. Mathematical analysis included methods of descriptive statistics, analysis of contingency table, where the value of χ2, the achieved level of significance (p) was estimated. Results. In the FEFD and SFD, over the COVID-19 2020 epidemic, the SARS-CoV-2 virus was revealed in 8485 pregnant women, women in labor and postpartum women (5.9% of pregnant women subjected to regular medical check-up;1.71% of the sick entire population). The incidence rate in pregnant women was 3.0 times higher than in the entire population: 5933,2 vs 1960,8 per 100 thousand (p<0.001). Among SARS-CoV-2 infected patients, 27.4% (2324) were asymptomatic, 52.7% (4471) have mild, 16.6% (1388) - moderate, 2.5% (210) - severe 0,5% (39) - extremely severe clinical course. In the intensive care and anesthesiology departments, 3.57% of pregnant women and 2.24% of the entire population (p<0.001) have been treated. Rate of using invasive artificial lung ventilation in pregnant women was lower than in the population: 0.48% vs 1.05% (p<0.001). 27.97% (2373) of women with confirmed NKI COVID-19 completed pregnancy. 81,7% of mothers delivered on time, 18.3% - prematurely. Cesarean delivery was performed in 42,0% of women, operative vaginal delivery (vacuum extraction, obstetric forceps) was registered in 0.2% of cases. 12 (0.14%) mothers died. The maternal mortality rate was 505.69 per 100 thousand live births (0.51% of patients with COVID-19 who gave birth). Mortality rates and the proportion of deaths in the entire population were statistically significantly higher: 1948.93 per 100 thousand sick population and 1.95% (p<0.001), respectively. 37 (1.56%) cases of perinatal losses were registered, of which 31 (1.30%) - stillbirths, 6 (0.26%) - early neonatal mortality. The SARS-CoV-2 virus was revealed in 148 (6.2%) newborns with the observance of anti-epidemic measures and separation of the mother and child immediately after delivery. Conclusion. The rate of revealing SARS-CoV-2 virus in pregnant women, women in labor and parturient women in Siberia and the Far East was 3.0 times higher than in the entire population, while clinical course of infectious process was less severe (less need for invasive mechanical ventilation, lower mortality rate). In mothers with COVID-19, preterm birth rate was 3.0 times higher, caesarean delivery rate -1.4 times higher compared with the average population indicators. Reveling SARS-CoV-2 virus RNA in 6.2% of newborns suggests the possibility of vertical transmission of the infection. © Gynecology 2021.
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The novel coronavirus infection (NCI) (COVID-19) pandemic has posed real social, political and health challenges to the entire world. Many aspects of the management and course of this infection are controversial. The physiological characteristics of a pregnant woman's body place her, on the one hand, at risk for a more severe course of NCI, which has been confirmed in some studies. However, other authors point out that COVID-19 in pregnant women occurs in the same fashion or even more easily than in the general population. There are limited data on the prevalence of NCI among pregnant women in the Russian Federation. There are reports of both maternal and neonatal NCI-related deaths worldwide. There is a limited range of drugs used to treat NCI in pregnant women. Etiotropic therapy with a combination of lopinavir and ritonavir can be performed. Some publications have shown the efficacy and safety of hydroxychloroquine in patients with severe NCI. A prevailing number of recommendations indicate that vaginal delivery is preferable for pregnant women with NCI;however, most of them deliver an infant via cesarean section. Spousal presence during childbirth and the possibility of breastfeeding remain controversial: from ban (before having a negative COVID-19 test) to measures to support the women. There are no convincing data on the possibility of COVID-19 vertical transmission, but this issue and the rehabilitation of pregnant women who have experienced NCI (COVID-19) require further investigations. Conclusion. Pregnancy and childbirth do not worsen the course of NCI (COVID-19). However, there are risks for some pregnancy complications, as well as neonatal ones, during both pregnancy and the long periods after the experienced NCI (COVID-19), especially its severe types. There are no convincing data on the possibility of COVID-19 vertical transmission, but this issue and the rehabilitation of pregnant women who have experienced NCI (COVID-19) require further investigations. © A group of authors, 2020.
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Aim. To evaluate an epidemiological characteristic and the course of COVID-19 in pregnant women from the Far East and Siberian Federal Districts of Russia. Materials and methods. The analysis of operational information on the incidence of COVID-19 and the its features in pregnant women and alter childbirth prov ided by the chief obstctrician-gynecologists of the Far F.astcrn Federal District and Siberian Federal District on Ma)-25, 2020 and August 25,2020 is carried out. Mathematical analysis included descriptive statistics methods, analy sis of contingency tables, where the x2 value, the achieved significance level (p). Results. On August 25, 2020, 2010 cases of COVID-19 in pregnant women were detected in two subjects, including 134 active cases. In the population, the proportion of pregnant women among cases of COVID-19 was 1.45%. Pneumonia in pregnant women was registered in 44.8% of cases, severe course of the disease-in 37%, hospitalization in RAW-in 1.9% of cases, mechanical ventilation-0. In the population, pneumonia was registered in 24.4% of cases, hospitalized in RAW-2.1%, on mechanical ventilation-0.77%. The incidence in pregnant women was 1464.7 per 100 000 (in the population-591-8 per 100 000). 23 (1.76%) COV1D-19 (+) newborns were identified, despite preventive measures and separation of mother and child immediately after childbirth, which docs not exclude vertical transmission of the disease. Maternal mortality was 2 (0.1%) cases vs population mortality 1.49%. Perinatal mortality was 7 (0.35%) cases. There were 5 (0.25;) stillbirths. Farly neonatal mortality was 2 (0.1%) cases. Conclusions. The incidence of COVID-19 in pregnant women in the Far East and Siberia is higher than in the general population with a higher incidence of pneumonia, but a milder course: Less need lor 1CU, mechanical ventilation and mortality. 23 cases of SARS-CoV-2-positivc newborns, despite the separation of mother and child, do not exclude the possibility of vertical transmission of infection. © 2021 Universidade de Sao Paulo. All rights reserved.
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The paper describes the healthcare service at the maternity hospital in the setting of an infectious hospital;describes the reception and sorting of pregnant women, women in labor, obstetric patients and newborns;analyzes indications for early and operative delivery, and provides the main results of maternity obstetric service in the presence of the pandemic. © 2020, Media Sphera Publishing Group. All rights reserved.
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The purpose of the study was to evaluate an epidemiological characteristic and the course of COVID-19 in pregnant patients from the Far Eastern Federal District and Siberian Federal District. Materials and methods. The analysis of operational information on the incidence of COVID-19 and the its features in pregnant women and after childbirth provided by the chief obstetrician-gynecologists of the Far Eastern Federal District and Siberian Federal District on May 25, 2020 is carried out. Mathematical analysis included descriptive statistics methods, analysis of contingency tables, where the chi2 value, the achieved significance level (p) and the communication intensity indicator V Cramer were evaluated. Results. Despite the more severe course of the COVID-19, in general, in the Far Eastern Federal District as compared with the Siberian Federal District, the main characteristics of the course of the disease in pregnant women in both districts did not differ significantly. The proportion of pregnant women among patients with COVID-19 was 0.61% in the Siberian Federal District, 1.1% in the Far Eastern Federal District, and averaged 0.82%. The course of the COVID-19 in pregnant women tended to be mild for pregnant women according to the main characteristics, such as the frequency of pneumonia - 25.5% and 30.7%, the hospitalization rate in ICU - 1.9% and 3.97%, as well as mechanical ventilation - 0% and 1.26%. However, there were no statistically significant differences with the course of the disease in the general population (p>0.05). There were no cases of maternal and perinatal mortality. Conclusion. Thus, the proportion of pregnant women among patients with COVID-19 in the Far Eastern Federal District and Siberian Federal District was 0.82%. The course of the disease in this category of patients was generally comparable with the general patient population. It will be possible to make a final conclusion about the characteristics of COVID-19 in pregnant women just after the pandemic is completed. Цель исследования - дать эпидемиологическую характеристику и оценить особенности течения новой коронавирусной инфекции COVID-19 у беременных Дальневосточного федерального округа (ДФО) и Сибирского федерального округа (СФО). Материал и методы. Проведен анализ оперативной информации о заболеваемости новой коронавирусной инфекцией (НКИ) COVID-19 и особенностях течения этого заболевания у беременных, рожениц и родильниц, предоставленной главными акушерами-гинекологами ДФО и СФО на 25 мая 2020 г. Математический анализ включал методы описательной статистики, анализ таблиц сопряженности, в ходе анализа оценивали значение chi2, достигнутый уровень значимости (р) и показатель интенсивности связи V Крамера. Результаты. Несмотря на более тяжелое течение НКИ COVID-19 в целом в ДФО по сравнению с СФО, основные характеристики течения заболевания у беременных в обоих округах существенно не различались. Доля беременных среди заболевших НКИ COVID-19 в СФО составила 0,61%, в ДФО - 1,1% и в среднем - 0,82%. Клинические проявления НКИ COVID-19 у беременных имели тенденцию к более легкому течению по основным характеристикам, таким как частота развития пневмонии - 25,5 и 30,7%, частота госпитализации в реанимационно-анестезиологическое отделение - 1,9 и 3,97%, а также применение искусственной вентиляции легких - 0 и 1,26%. Однако не отмечено статистически значимых различий с тяжестью заболевания в общей популяции (p>0,05). Случаев материнской и перинатальной смертности не было. Выводы. Доля беременных среди заболевших новой коронавирусной инфекцией COVID-19 в ДФО и СФО составила 0,82%. Течение заболевания у этой категории пациенток в целом сопоставимо с таковым в общей популяции больных. Только после завершения пандемии можно будет сделать окончательное заключение об особенностях этого заболевания у беременных.
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This review provides current information on the different aspects of restoration of reproductive health in women who recover from COVID-19. The article addresses various issues such as pregnancy management in women who recover from COVID-19, prevention of complications, recommendations for pregnancy planning, contraception and the use of assisted reproductive technologies in women who recover from COVID-19. The review reflects practice guidelines of international professional communities, including the RCOG (Royal College of Obstetricians and Gynecologists) and ESHRE (European Society of Human Reproduction and Embryology). The relationship between the psychological state of women who recover from COVID-19 and reproductive health is also considered. © 2020, Media Sphera Publishing Group. All rights reserved.
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This review provides current information on the impact of the new coronavirus infection COVID-19 on the management of patients in obstetrics and gynecology. The article addresses various issues such as pregnancy and neonatal management, different aspects of gynecological surgery and the use of assisted reproductive technologies during the COVID-19 pandemic. The review reflects practice guidelines of international professional communities, including the World Health Organization, RCOG (Royal College of Obstetricians and Gynecologists), ACOG (American College of Obstetricians and Gynecologists), RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists), as well as Temporary guidelines of the Ministry of Health of the Russian Federation on the prevention, diagnosis, and treatment of new coronavirus infection.