Statistics of deaths during childbirth. Mortality during childbirth in russia, usa and beyond

No one is safe from death, and we all die sooner or later. As Epicurus said: “Do not be afraid of death - while you are, it is not, but when it comes, you will not be.” But, of course, a separate line should be highlighted from what a woman in labor or the causes of maternal death can die. I would like to immediately reassure pregnant women: in recent years, the percentage of maternal mortality has significantly decreased and continues to decline, so do not be afraid to become pregnant and give birth.

Thus, the maternal mortality rate for 2007 in Russia is 22 per 100,000 births, while in 2000 it was 40.3. For example, in Sweden and Norway this figure is 6, and in African countries 400-800 deaths per 100,000 births.

What is maternal mortality?

According to the definition of the World Health Organization, maternal mortality is the death of a woman who occurs during pregnancy, regardless of its location and duration, or within 42 days from any cause associated with pregnancy or aggravated by its management, but not from an accident or an accidental cause. .

Again, the WHO contradicts itself. An ectopic pregnancy is officially considered a disease, and the death of a woman from an ectopic pregnancy refers to maternal mortality. Late maternal mortality is considered to be the death of a woman at 28 weeks of pregnancy or more and within 42 days after childbirth, but not more than a year. Late maternal mortality can be divided into 2 groups:

• death that is directly related to obstetric causes (complicated pregnancy, childbirth, the postpartum period and death as a result of diagnostic interventions and improper treatment);
• death indirectly related to obstetric causes (a disease present and occurring during pregnancy that has no connection with an obstetric cause, but is aggravated by the influence of pregnancy).

Thanks to statistics, it has been found that more than 70% of maternal deaths are reversible. That is, the deaths of pregnant women, women in childbirth and puerperas can be mainly blamed on poor-quality equipment, low qualifications of doctors and the level of obstetric care.

Structure of maternal mortality

• Obstetric bleeding (22 - 23%)

Obstetric bleeding ranks first among the causes of maternal death and is divided into bleeding during pregnancy, childbirth and in the postpartum period. Bleeding during pregnancy occurs with placenta previa and detachment of a normally located placenta. Also during pregnancy, uterine rupture along the scar is possible.

Bleeding during childbirth occurs either as a result of placental abruption or uterine rupture due to a number of reasons - a large fetus and fetal head, incorrect insertion of the head, transverse position of the fetus, a clinically narrow pelvis, discoordination of labor, tumors of the uterus and ovaries, scarring of the cervix and bone exostoses of the small pelvis. Bleeding in the afterbirth and early (2 hours) postpartum period occurs due to congenital and acquired disorders of blood clotting, improper separation and discharge of the placenta, trauma (ruptures) of the soft tissues of the birth canal, atony and hypotension of the uterus (for example, with improper use of reducing agents).

Preeclampsia of pregnant women (17 - 19%)

Gestosis of pregnant women are in second place in the causes of maternal death and are manifested by dropsy of pregnant women, nephropathy (edema, protein in the urine, high blood pressure), preeclampsia and eclampsia. Eclampsia is the most dangerous complication of preeclampsia and is manifested by convulsions, respiratory arrest, falling into a coma, and in case of untimely assistance, the death of the mother and child.

Extragenital diseases (14 - 15%)

The third place among the causes of maternal mortality can be safely given to extragenital diseases. The researchers found that extragenital diseases account for the lowest percentage of preventability due to the fact that many women were contraindicated in pregnancy (for example, with heart defects).

Purulent-septic diseases (14 - 15%)

In fourth place in maternal mortality are purulent-septic diseases in the postpartum period. Especially often, inflammatory processes complicate the postoperative (after cesarean) period. When endometritis occurs, the temperature rises (up to 39 - 40 degrees), the discharge (lochia) becomes purulent and with an unpleasant odor, weakness, chills, and lack of appetite appear. The uterus contracts poorly or does not contract.

Anesthetic complications (6 – 7%)

Anesthetic complications rank fifth and include: aspiration syndrome, complications of subclavian vein catheterization, allergy to pain medications (anaphylactic shock), overdose of anesthetics, incorrect infusion therapy, and complications during epidural and spinal anesthesia.

Amniotic fluid embolism (6%)

In sixth place in the structure of maternal mortality is amniotic fluid embolism, which develops either with a significant excess of amniotic fluid pressure over venous pressure, or with gaping venous vessels. A sharp increase in amniotic pressure occurs with rapid delivery, breech presentation of the fetus, large fetus, multiple pregnancy, tight cervix, early opening of the fetal bladder, diabetes mellitus, heart defects, preeclampsia, stimulation of labor. The gaping of the uterine vessels is noted with placenta previa and abruption, cesarean section, atony of the postpartum uterus, traumatic non-penetrating uterine ruptures.

Uterine ruptures (4 - 5%)

And complete the list of causes of death of pregnant women and women in childbirth uterine ruptures. With the onset of uterine rupture, too frequent and very painful contractions appear, the fetal heart rate is higher or lower than normal (normal 120 - 140 beats per minute), the woman complains of severe pain. Uterine ruptures are two to three times more common in nulliparous than in multiparous women.

Anna Sozinova

In Stavropol, investigators are checking the ambulance hospital. A young mother died there. In the hospital, she gave birth to her third child and died a few hours later. Relatives claim that 33-year-old Tamara was healthy before she got to the hospital.

She felt great, all nine months of pregnancy she was under the supervision of doctors, she passed all the tests - everything was fine, ”Semyon Gasparyan, a relative of the deceased (sister’s brother), tells Life.

According to the terms, it was necessary to give birth, but the contractions had not yet begun, stimulation was needed, ”says Semyon. - The doctor decided that there was no need to overexpose, the fetus was already large. Around 20:00 began to stimulate childbirth. The last time Tamara communicated with her family was around 21:30 via WhatsApp. She said that everything was fine, that the contractions had begun and that she would soon give birth.

As a result, as it turned out later, Tamara had a caesarean section. Denis agreed with the doctor Tatyana Babenko that if Tamara is unable to write after the birth, the doctor herself will call him back.

Denis tried to call the doctor all night, but she did not pick up the phone. At about 7:30 in the morning, the husband was about to go to the hospital, and then the doctor called him and said that everything was fine with the child, and Tamara died of a thromboembolism, continues Semyon.

This compound word means that a blood clot forms on the vessel wall - a thrombus, which then breaks off and enters the circulating blood. The clot clogs the vessel - and the blood stops flowing. The consequences depend on which vessel is clogged. For example, thromboembolism of the cerebral vessels leads to a stroke.

The cesarean was done at 1:30. It is not clear what the doctors did in such a long time period from birth to morning. Familiar doctors said that after a cesarean Tamara was left in intensive care for two hours unattended - and she died from bleeding, says Semyon.

According to him, no one apologized to the family.

The doctors were terrible. They did not make any apologies, did not express any compassion, they just said that this happens, says Semyon. - Tamara was 33 years old. The newborn boy now lives with his grandmother. A strong, healthy baby weighing 4.3 kg was born, similar to his mother. They named him Damir. The older children are Timur (11 years old) and Ruslan (seven years old).

Life sent a request to the hospital, but we did not receive a response.

Pathologists will try to ensure that no one knows the cause of death

Maternal mortality is something that the Ministry of Health constantly reports on. This indicator, according to the plans of the Ministry of Health, should become better year by year. And he becomes. Recently, for example, the chief pathologist of the Volgograd region Vadim Kolchenko. As it turned out, he improved the indicator "maternal mortality" - as best he could.

Vadim Kolchenko changed the results of the autopsy of 29-year-old Elena Machkalyan - in 2017 she had a dead son, and a few days later she herself died. The pathologist determined that Elena died due to a viral infection. But in the documents, Kolchenko wrote that death was due to problems with the liver, which allegedly had been there for a long time.

At the same time, he replaced Elena's liver samples with samples from a deceased man. All this became known only because Elena's widowed husband tried with all his might (and is still trying to achieve) that an investigation be carried out. And at first, no one even wanted to initiate a criminal case.

In general, this is all you need to know about medical statistics in Russia. But if you want to know how Rosstat and the Ministry of Health are doing, then everything is fine with them. How, according to the Ministry of Health, in 2017, maternal mortality decreased by 27%. If in 1990 about 48 out of 100,000 women in childbirth died, now there are about seven.

Life earlier, how the Ministry of Health underestimates mortality from cardiovascular diseases - scientists from the Central Research Institute for the Organization and Informatization of Healthcare conducted a real investigation into this matter. It turned out that the dead posthumously are specially diagnosed with incorrect diagnoses - for example, diabetes mellitus or nervous diseases.

Mortality from these diseases is growing on paper, but the Ministry of Health does not particularly publicly report on them, but mortality from cardiovascular diseases is declining on paper - and in this regard, the Ministry of Health praises itself from year to year. It is possible that something similar is happening with maternal mortality figures.

There is a lot of news about deaths in maternity hospitals. Just a few days ago, Life about the death of a resident of Rostov-on-Don. She was 25 years old, she gave birth to her first child and died four days later.

According to relatives, the pregnancy of the deceased proceeded well. On the appointed date, she underwent a caesarean section, and after the birth of the baby, she was transferred to the ward. The girl felt bad immediately after giving birth, which she reported to the doctors, but they did not react in any way.

When the doctors remembered the patient, Yulia was already unconscious. Later she fell into a coma, - relatives of the woman in labor said.

The news usually talks about the fact of death itself and about the assumptions of relatives. But if you read the materials of the courts, where the stories of cut short lives are later transferred, then everything is already sorted out there. There is more hopelessness in these stories.

The doctor admitted that he did not know how to perform operations

In April 2018, the Ershovsky District Court of the Saratov Region considered a criminal case against an obstetrician-gynecologist and anesthetist at a hospital in the village of Dergachi. In short, they just killed their patient.

The woman in April 2017 gave birth to her first child, after which she began to uterine bleeding. The obstetrician-gynecologist decided that the patient needed to have a curettage of the uterus (to separate the placenta from its walls). The bleeding continued, and then the doctor began an operation to partially remove the uterus. As he later admitted, he considered that the entire uterus should be removed, but did not know (!) how to do it, so he decided to remove at least part of it.

Since this sounds absolutely incredible, let's quote the text of the court's decision: "He decided to perform a supravaginal amputation of the uterus, while the decision to conduct surgery in the indicated volume was due to the fact that he does not own the technique for complete removal of the uterus."

Before the operation, the anesthesiologist took over the martyr. He prescribed drugs that should not be used for bleeding, that is, he only made it worse.

The woman died of profuse bleeding and cardiac arrest. The text of the decision says that before the operation, the doctors did not pay attention to the blood test, namely, the number of platelets. But these elements are responsible for blood clotting, that is, the power of bleeding directly depends on their quantity.

In addition, many more mistakes were made: the patient did not have an ultrasound, her clavicular veins were damaged, medical aviation was not called to rescue her (to take her to another hospital), they gave her little painkiller - so she also died in agony.

The court gave doctors two years of restriction of freedom. They were forbidden to return home after 22:00 and to leave the area without the permission of the controlling authority.

The device just didn't turn on.

In March 2018, the Birobidzhansky District Court of the Jewish Autonomous Region recovered 1.5 million rubles from the Obluchensky District Hospital. This is compensation for the death of a patient - a young mother of three children (her name is hidden in the case - this is done to preserve confidential data, let's call her conditionally Natalia). The lawsuit was filed by Natalya's mother - her name is Tatyana Nikolaevna.

Natalia had a caesarean section. Everything went well, only the anesthesiologist could not put the catheter into the vein for a long time. First, the doctors "did not find any veins in the elbows." Secondly, the anesthesiologist "tried to place a subclavian catheter, but several attempts failed." Finally, they decided to put in the jugular vein (on the neck).

A few hours after the operation, Natalia felt unwell. It was difficult for her to breathe, there seemed to be a lump in her throat, her strength completely disappeared. The patient was put on a drip. At first she seemed to get better, but then - even worse. Natalya was "put on a gurney, taken to the x-ray room."

These were decisive minutes - the woman needed immediate help. And the saddest detail in this whole story - "the X-ray machine did not turn on." It just didn’t turn on, as if it were some kind of printer in the library, and not an apparatus for salvation, which should be strictly controlled and which cannot be taken and not turned on.

Later, experts from the Bureau of Forensic Medical Examinations of the Health Department of the Jewish Autonomous Region arrived at the hospital with a check. They concluded that death "was the result of stab and atrogenic (medical) injuries of the subclavian veins," the court decision says.

The anesthesiologist tried to put catheters in them - as a result, the veins were damaged and blood got into the tops of the lungs. Cardiopulmonary insufficiency developed.

"This cause of death is indicated by those found during autopsy (that is, autopsy. - Note. Life) ... the presence of hemorrhages in the circumference of the subclavian vessels, extending up to the paravertebral tissue of the upper thoracic vertebrae, the presence of air in the pleural cavity, collapse (atelectasis) of the lungs on both sides," the court's decision says.

Representatives of the hospital in court tried to insist on a reduction in compensation or even its abolition. They insisted that the doctor's guilt had not yet been proven in court (a separate criminal case had been initiated against him).

What to do?

If we have such cases, it means that the quality of the work of the Ministry of Health is insufficient, ”said Yan Vlasov, co-chairman of the All-Russian Union of Patient Organizations. - There is the so-called Juran rule, it follows that the poor quality of medical care is only 15% dependent on the qualifications of a specialist and 85% on the work of an administrator. That is, the selection of personnel is carried out unprofessionally. The level of responsibility of doctors for failing to fulfill their duty is low, and the level of responsibility of healthcare administrators who organize the process is none at all.

What can you advise a family that does not have a million rubles for childbirth in an elite clinic or a familiar doctor whom they definitely trust?

It is better to get into a large multidisciplinary medical institution, where there are many doctors, - said Yan Vlasov. - If possible, people should prepare for the upcoming event. A woman, when she registers, can get acquainted with her gynecologist and obstetrician. That is, it is better if she sees them not for the first time in the maternity hospital, but knows in advance who they are and how they behave. And if something alerts the patient, then she will at least have the opportunity to ask another doctor.

Also see all kinds of ratings of medical institutions and patient reviews. Just don't forget that reviews are usually written by those who have suffered, and patients who are doing well just go home and live their lives. So if a hospital has five bad reviews and none good, it doesn't mean that all the patients were bad.

Now the public councils under the regional departments and ministries of health and citizens are rating, - said Yan Vlasov. - Approximately these ratings can be trusted.

But, unfortunately, the patient cannot always protect himself from medical errors.

Here, rather, it is not a question of where the patient should go, but a question for the healthcare organizer: "Is there any place to go?" - said Yan Vlasov.

Maternal mortality is one of the main criteria for the quality and level of organization of the work of obstetric institutions, the effectiveness of the introduction of scientific achievements into healthcare practice. However, most leading experts consider this indicator more widely, considering maternal mortality as an integrating indicator of the health of women of reproductive age and reflecting the population outcome of the interactions of economic, environmental, cultural, socio-hygienic and medical-organizational factors.

Causes of death during childbirth

This indicator allows you to evaluate all losses of pregnant women (from abortions, ectopic pregnancy, obstetric and extragenital pathology during the entire gestation period), women in labor and puerperas (within 42 days after termination of pregnancy).

In the International Classification of Diseases and Related Health Problems, 10th revision (1995), the definition of "maternal mortality" has not changed much compared to ICD-10.

Death during childbirth is defined as pregnancy-related death (regardless of its duration and location) of a woman during pregnancy or within 42 days after its termination from any cause associated with pregnancy, aggravated by it or its management, but not from accident or accidental cause.

At the same time, a new concept has been introduced - "late maternal death". The introduction of this new concept is due to the fact that there are cases of death of women that occurred later than 42 days after the termination of pregnancy from causes directly related to it and especially indirectly related to pregnancy (purulent-septic complications after intensive care, decompensation of cardiovascular pathology, etc.). d.). Accounting for these cases and analyzing the causes of death allows us to develop a system of measures to prevent them. In this regard, the 43rd World Health Assembly in 1990 adopted a recommendation that countries should consider including items relating to current pregnancy and pregnancy in the year preceding death on the death certificate and adopt the term "late maternal death.

Deaths during childbirth are divided into two groups:

1. Death directly attributable to obstetric causes: death due to obstetric complications, the state of pregnancy (i.e. pregnancy, childbirth and the postpartum period), and as a result of interventions, omissions, improper treatment, or a chain of events following any of these causes.
2. Death indirectly attributable to obstetric causes: death resulting from a pre-existing disease or disease that developed during pregnancy, not due to a direct obstetric cause, but aggravated by the physiological effects of pregnancy.

Along with the indicated (main) causes, it is advisable to analyze the accidental causes of death (accidents, suicides) of pregnant women, women in childbirth and puerperas within 42 days after the completion of pregnancy.

The rate of death during childbirth is expressed as the ratio of maternal deaths from direct and indirect causes to the number of live births (per 100,000).

birth death statistics

Every year, more than 200 million women in the world become pregnant, which in 137.6 million ends in childbirth. The share of births in developing countries is 86% of the number of births worldwide, and death in childbirth is 99% of all maternal deaths in the world.

The number of deaths in childbirth per 100,000 live births varies widely across parts of the world: Africa 870, South Asia 390, Latin America and the Caribbean 190, Central America 140, North America 11, Europe 36, Eastern Europe - 62, Northern Europe - 11.

In economically developed countries, low rates of death during childbirth are due to the high level of economic development, the sanitary culture of the population, low birth rates, and the high quality of medical care for women. In most of these countries, childbirth is carried out in large clinics equipped with modern diagnostic and treatment equipment and qualified medical personnel. The countries that have achieved the greatest success in protecting the health of women and children are characterized, firstly, by the full integration of the components of maternal and child health and family planning, the balance in their provision, financing and management, and secondly, the full availability of assistance in planning families within the health services. At the same time, the reduction in maternal mortality was mainly achieved through the improvement of the situation of women, the provision of maternal health and family planning within the framework of primary health care and the creation of a network of district hospitals and perinatal centers.

About 50 years ago, countries in the European Region for the first time institutionalized health care systems for pregnant women based on routine examinations and periodic visits to a doctor or midwife. With the advent of more sophisticated laboratory and electronic equipment, a large number of tests have been introduced and the number of visits has changed. Today, every country in the European Region has a legally established or recommended system of visits for pregnant women: for uncomplicated pregnancies, the number of visits varies from 4 to 30, averaging 12.

Statistics of death during childbirth in Russia

According to the State Statistics Committee of Russia, over the past 5 years, the death rate during childbirth has decreased by 27.2% (from 44.2% in 1999 to 31.9% in 2003 per 100,000 live births), and the absolute the number of maternal losses decreased by 74 cases (from 537 to 463 cases, respectively). The absolute number of deaths after abortions during this period decreased by more than 40% - from 130 to 77 cases, respectively.

According to the State Statistics Committee of Russia, the structure of causes of death during childbirth in 2003 in the Russian Federation remained virtually unchanged. As before, more than half of maternal deaths (244 cases - 52.7%) are determined by the three leading causes: abortion (77 cases - 16.6%), bleeding (107 cases - 23.1%) and pregnancy toxicosis: 60 cases - 13 .0% (Table 1.10).

Of the deceased, more than 7% die at the age of 15-19 (2.4% at the age of 15-17 and 5% at the age of 18-19), which is 11 and 23 cases of maternal death, respectively.

The maternal mortality rate per 100,000 live births by federal districts (Table 1.11) fluctuates by more than 2 times - from 20.7 in the Northwestern Federal District to 45.5 in the Far Eastern Federal District (Russian Federation 31.9). In 2003, compared with 2002, a decrease in the maternal mortality rate was noted in 6 districts of the Russian Federation - from 1.1% in the Far Eastern Federal District to 42.8% in the Urals Federal District, with the exception of the Siberian Federal District, where an increase in the indicator was noted maternal mortality by 26.0%.

In 2003, according to the State Statistics Committee of Russia, death during childbirth was not registered in 12 territories: the Republic of Komi, the Republic of Altai, the Karachay-Cherkess Republic, the Kaliningrad and Kamchatka regions and in 7 autonomous regions with a small number of peoples: Chukotsky, Koryaksky, Komi- Permyatsky, Taimyrsky (Dolgano-Nenetsky), Evenksky, Ust-Ordynsky, Buryatsky, Aginsky Buryatsky; in 13 territories, the maternal mortality rate is below 15.0; in 4 territories, the maternal mortality rate exceeds 100.0 (Nenets Autonomous Okrug, the Republic of Mari El, the Jewish Autonomous Region and the Republic of Tyva).

Data for the subjects of the Russian Federation are presented in Table. 1.12.

The share of deaths after abortion among the total number of deaths classified as maternal mortality ranges from 3.7% in the Northwestern Federal District to 22.2% in the Volga Federal District (Russian Federation - 16.6%), and the maternal mortality rate after abortions per 100,000 live births - from 0.77 in the Northwestern Federal District to 9.10 in the Far Eastern Federal District (Table 1.13).

It is noteworthy that with a decrease in the overall maternal mortality rate in the Russian Federation as a whole in 2003 by 5.1%, there was a decrease in it among the urban population by 10.0% (from 30.0 in 2002 to 27.0 % in 2003) with an increase in the indicator among the rural population by 4.5% (42.6 and 44.5%, respectively).

Every year, the rate of death during childbirth among women in rural areas in the Russian Federation as a whole exceeds the same indicator among women in urban settlements: in 2000, 1.5 times; in 2002 by 1.4 times, in 2003 by 1.6 times, and in three districts (South, Ural, Far East) - more than 2 times. The indicator of medical mortality among the rural population by federal districts in 2003 ranges from 30.7 in the Northwestern to 75.8 in the Far East (Table 1.14).

There is also a difference in the structure and causes of maternal mortality. Thus, in 2003, the rate of death during childbirth among women in rural areas exceeded the same indicator among women in urban settlements after an abortion started and started outside a medical institution by 2.1 times, from postpartum sepsis - 2.1 times, from toxicosis pregnancy - 1.4 times, from bleeding during pregnancy, childbirth and the postpartum period (in total) - 1.3 times. In total - from septic post-abortion and post-natal complications - in 2003, every fourth of the number of deaths belonging to the category of maternal mortality died.

An expert assessment of maternal mortality showed that deaths during childbirth due to medical errors can be divided into two groups: those caused by the activities of an anesthesiologist-resuscitator and an obstetrician-gynecologist.

The main complications caused by the action of anesthesiologists were:

• complications of resuscitation and repeated attempts of punctures and catheterization of the subclavian veins;
• traumatic injuries of the oral cavity, larynx, pharynx, trachea, esophagus;
• bronchospasm, regurgitation, Mendelssohn's syndrome;
• intubation difficulties, post-anoxic encephalopathy;
• puncture of the dura mater during epidural anesthesia;
• inadequate infusion therapy, often excessive.

The main complications caused by the activities of obstetrician-gynecologists include:

• traumatic injuries of the abdominal organs;
• divergence of the ligature;
• delay in surgical intervention, including hysterectomy;
• failure to provide necessary medical assistance.

In order to reduce deaths during childbirth among rural women, the following measures are needed.

1. Carry out a more thorough selection among rural women at risk of maternal death (establish monitoring), and refer them to antenatal hospitalization in high-risk institutions.
2. Given the high proportion of deaths from postpartum sepsis, implement a more balanced individual approach to the early discharge of puerperas living in rural areas, taking into account the medical and social risks of purulent-septic postpartum complications, as well as establish mandatory patronage of puerperas by the medical staff of FAPs and FPs (in accordance with with Order No. 345 of November 26, 1997) and to train primary healthcare personnel in the diagnosis of purulent-septic postpartum complications, including their early clinical manifestations.
3. Taking into account the large proportion of deaths after abortions initiated and / or started outside a medical institution, take measures to increase the availability of artificial abortions, including short-term abortions, at the expense of state guarantees for the provision of free medical care, and also pay special attention to the prevention of unplanned pregnancies among women living in rural areas and to organize the provision of them, as the most socially unprotected and poor strata of the population, with free effective contraceptives.
4. Provide free transport for pregnant women and women in the postpartum period from rural areas to the level of the Central District Hospital and from the Central District Hospital to the level of regional (territorial, republican) institutions for dispensary observation and, if necessary, consultation and treatment at a high-risk hospital.
5. Provide rural women with high-tech and specialized gynecological care (endoscopic operations, organ-preserving operations, etc.).

Prevention of death in childbirth

In recent years, the strategy of the obstetric service has been built on the basis of two principles: identifying pregnant women at high risk of perinatal pathology and ensuring continuity in the provision of obstetric care. Much of the attention paid to perinatal risk in the 1970s began to wane in the 1990s.

Another important feature of pregnancy care systems is the continuity of care. In Europe, the vast majority of systems treat pregnancy, childbirth, and the postpartum period as three separate clinical situations, requiring the application of a variety of clinical expertise, the use of different medical staff and different clinical settings. Therefore, in almost all countries there is no continuity of care provided during pregnancy and childbirth, i.e., one specialist conducts a pregnant woman, and another, who has not previously observed her, conducts childbirth. Moreover, the change of personnel every 8 hours of work also does not ensure the continuity and succession of care during childbirth.

The Netherlands, a developed European country with a highly organized home delivery system (36%), has the lowest rate of death during childbirth and newborns. Low-risk pregnancies and home births are monitored by a midwife and her assistant, who assists in the delivery and stays at home for 10 days to help the mother.

In most European countries, a standardized pregnancy history is kept by a midwife or doctor to record the association between care during pregnancy and care at delivery. This document is kept by the pregnant woman, who brings it with her to the birth.

In Denmark, the law allows for home births, but some counties have secured permission to deviate from the rule due to a shortage of midwives. Childbirth without the help of a professionally trained person is illegal in the UK and Sweden. In North America, unassisted home births are not illegal.

In the United States in 1995, death during childbirth was 7.1 per 100,000 live births. The main causes of death were: complications of the postpartum period (2.4 or 33.8%), other causes (1.9 or 26.7%), preeclampsia of pregnant women (1.2 or 16.9%), bleeding (0.9 or 12.7%), ectopic pregnancy (0.5 or 7%).

The largest volume of prenatal care falls on the first trimester of pregnancy

In Russia, mortality and life expectancy statistics are extremely unfavorable for liberals and other scumbags. Life expectancy has reached a historical maximum - 72.6 years, since 2005 it has grown by 7.2 years: for men - by 8.6, for women - by five years. Which explains the inevitability of raising the retirement age, if not to Scandinavian standards, then at least to minimal European ones.

However, the statistics on the death of women in childbirth in Russia, which is not included in the list of developed countries, and those very “developed” ones that lead the States, are much more revealing. Let's start with us.

According to the data for 10 months of 2017, death among women in childbirth in Russia amounted to 7.3 per 100 thousand. I don’t want to point my finger at the USSR, then, nevertheless, medicine was worse not only in our country, but the mortality rate 30 years ago was an order of magnitude higher.

As for the United States and others, it is the States that have been named the most dangerous country for childbirth among developed countries. The results of their own investigation were published by USA Today, and not by some “Putin's agents”.

According to the American edition, every year more than 50,000 American women are injured, and about 700 mothers die during childbirth. It is estimated that more than half of accidents can be prevented. However, this requires better medical care.

The publication accessed more than 500,000 internal hospital quality records and studied the cases of more than 150 women whose deliveries were unsuccessful. The journalists also contacted 75 maternity hospitals to find out if the doctors were following the established guidelines.

The information collected indicates that medical personnel are violating regulations, which puts the health of mothers at risk. In particular, nurses often fail to measure the blood pressure of patients, which can lead to a heart attack. At some hospitals in New York, Pennsylvania, North and South Carolina, less than 15 percent of women in need of treatment received the care they needed. It is noted that a similar situation can be observed both in district and large city medical centers.

According to USA Today, the most dangerous states for childbearing are Louisiana, Georgia and Indiana. More than 40 out of 100 thousand women in childbirth die in them. In general, in the United States from 1990 to 2015, the number of deaths during childbirth increased from 17 to 26.4 per 100 thousand. At the same time, in Germany, France, Japan, Britain and Canada, the same figures fell to 5-10 people.

If we compare with our statistics, we just fall into these 5-10 deaths per 100 thousand. But the United States, which relies on an increase in the number of consumers due to visitors, spit on women in labor and mortality is growing, and not falling, as it is in our country.

The perinatal center of the Belgorod Regional Clinical Hospital of St. Joasaph is the best maternity hospital in the Belgorod region. That is why the Mozhaitsevs, who were expecting twins, came here this spring. Yulia Mozhaytseva felt good throughout her pregnancy, she even drove a car herself, none of the doctors suggested that there was any serious danger for her.

“There was no better than Yulia and there is no one in the world”

In their house, right at the entrance, you see a photo portrait: a smiling family in an embrace - Peter, Yulia and their daughter Vika, and the inscription: “Love is like this only happens once ...” He is a 34-year-old truck driver engaged in cargo transportation, she is a history teacher. He comes from the Novoskolsky district, from a large family, she is a native Belgorod. They lived in perfect harmony for more than 10 years, built a two-story house, raised a daughter and really wanted more children. In August of this year, Yulia Mozhaytseva would have turned 32 years old. Now she is gone, and her husband is left with three daughters in his arms, two of which are baby twins. At the end of May of this year, Yulia died during childbirth in the regional Perinatal Center.

A month and a half has passed since the death of his wife, and Peter still does not find a place for himself, cannot work normally. I wrote a letter to the AiF, in order to somehow take my soul away, told in detail everything that happened when I met with the AiF-Belgorod correspondent.

“We really wanted a second child, but Yulia couldn’t get pregnant for a long time,” he recalls. - They even wanted to go to Moscow for IVF. Then, in November 2007, when they found out that Yulia was expecting a baby, they were extremely happy. And when they told us at the ultrasound that there would be twins, they were simply delighted.

They met Svetlana Raikova, a doctor at the Perinatal Center, in March 2008, and they decided that she would be watching Yulia and assisting in childbirth. Twice in April and May Yuliya was kept in the Perinatal Center. By the end of May, the woman developed edema.

Since she gave birth to her first daughter through a caesarean section, and given that twins are expected, the doctor recommended that she go to the hospital in advance. On May 30, Yulia became ill, she was placed in intensive care. The next day, Peter talked to her on the phone and heard that she was feeling better. But on the same evening of May 31, at about 6 pm, she told her husband that she was worse again. This was their last conversation. At about 9 pm Raikova called him and congratulated him on the birth of two girls, whose weight is 2380 kg and 2090 kg is normal for twins. When asked about his wife's condition, the doctor replied that Yulia was in intensive care, and said that he should come the next day at 11 o'clock, bring mineral water without gas and lemon.

- At 6 am on June 1, I call the hospital, ask about my wife, and they tell me: “Better come,” recalls Peter. - My mother-in-law and I immediately left. None of the doctors met us, and the guard at the gate said: “Are you relatives of the woman who was taken to the morgue?” Then some unfamiliar doctor came out and said that his wife's heart could not stand it.

But Svetlana Raikova never spoke to her relatives.

- Everyone explained to us what happened, everyone brought condolences and apologies, except for her! - Pyotr Mozhaytsev is indignant. - They told me that she was frightened, confused, that when she realized that it was too late to change something, she called all the doctors, and at night they rushed to the maternity hospital on what. I don't blame the doctors who did the second operation, who tried to revive her. There is so much talk about the Perinatal Center everywhere, but not a word about our tragedy!

9-year-old daughter Vika is now support and comfort for her father. She somehow immediately matured, and before she was so carefree. The little ones are looked after by Petra's sister, 36-year-old Natalya, who took care of the children up to a year and a half. Other relatives also help. So it is impossible to say that Peter was left alone with his misfortune. But he himself does not know how to live on.

- At the funeral, they told me, they say, do not distribute Yulia's things until forty days, - he says. “They don’t understand, for me it’s like a museum: you open the closet, there are her dresses, perfume, her smell, and it seems as if she is nearby.

When leaving on a business trip, instead of an icon, Peter takes a photo of his wife with him.

“She followed me like a small child,” he recalls. “When I left, I wrote letters about love and gave them back when I returned. She never raised her voice, neither with me, nor with my parents, not even once - not a single conflict, they lived in such love that everyone envied.

How about now?

"No one is safe from death in childbirth"

Mortality cases associated with pregnancy and childbirth are very rare, but they have a special social significance, this is grief for the family and loved ones, children often remain orphans, - says Natalya ZERNAEVA, head of the Department of Medical Problems of the Family, Motherhood, Childhood and Demographic Policy. - The death of Mozhaytseva Yulia Vyacheslavovna in the perinatal center of the regional clinical hospital, which is the leading obstetric facility in the region and where highly qualified medical care is provided for women with complicated childbirth and serious illnesses, is hard experienced by all medical workers involved in pregnancy and childbirth.

A commission was set up in the department of health and social protection of the population of the region to find out the reasons that led to the tragedy. During the service check, all stages of medical care were analyzed. Yulia's pregnancy was complicated by preeclampsia in the second half of pregnancy, and therefore she was hospitalized and received treatment not in the usual department of pathology of pregnant women, but in the intensive care unit of the perinatal center.

The ongoing therapy made it possible to stabilize the course of the disease, however, due to the onset of rupture of the uterus along the scar (in the first birth, a “caesarean section” was performed), amniotic fluid entered the vascular bed. Amniotic fluid embolism, confirmed by histological examination, is an unavoidable cause of death. From 23:00 on May 31 to 06:00 on June 1, a team of the best specialists tried to save Yulia's life, everything possible was done.



- Maternal mortality in this pathology is 85 percent, these are global figures, - says the deputy chief physician of the regional hospital of St. - Over the past 10 years, we have not had a single similar case at the Perinatal Center, and of course, we all are very worried and sympathetic to this family.

According to Lidia Sergeevna, Svetlana Raikova, a doctor with 10 years of experience, came from Kursk and has been working in the perinatal center since 2004. At the moment, since that incident, she is on vacation, and possibly out of the area.

I don’t want to make excuses, I understand my relatives who blame the doctor, but doctors are not omnipotent, says Lidia Sergeevna.

The babies are monitored directly by the specialists of the perinatal center. Organized special meals for babies. Disciplinary measures were applied to the employees of the perinatal center.

- Members of the commission talked with Yulia's relatives, all the reasons that led to the tragedy were explained, - says Natalya Zernaeva. - However, the grief of the family is incommensurable with any of our explanations. Once again, I want to apologize and express my deepest condolences to the family of Yulia Vyacheslavovna Mozhaytseva on behalf of myself and all medical workers. Forgive us!

... Yulia's mother Lyubov Alekseevna, recalling with tears how white, without a single blood, her daughter was in a coffin, says:

For doctors, this is just a case. And how can we live? For all of us, this is grief for life.