Why dying during childbirth. Female generation of childbirth in women: why do they die and what are the measures to prevent mortality during children

20.07.2019

Maternal mortality - one of the main quality criteria and the level of organization of the work of the anniversary institutions, the effectiveness of the introduction of scientific advances in the practice of health care. However, most of the leading specialists consider this figure more widely, considering maternal mortality in the integrating indicator of the health of women of reproductive age and reflecting the population result of the interactions of economic, environmental, cultural, socio-hygienic and medical and organizational factors.

Causes of death during childbirth

This indicator makes it possible to estimate all the losses of pregnant women (from abortion, ectopic pregnancy, obstetric and extragenital pathology during the entire period of gestation), feminines and herds (within 42 days after the cessation of pregnancy).

In the international classification of diseases and problems associated with health, the 10th revision (1995), the definition of "maternal mortality" has not changed compared to the ICD-10.

Death during childbirth is defined as determined by the pregnancy (regardless of its duration and localization) the death of a woman who has occurred during pregnancy or within 42 days after its ending from any reason related to pregnancy, burdened by it or its leading, but not from Accident or accidentally caused cause.

At the same time, a new concept was introduced - "Late Motherland". The introduction of this new concept is due to the fact that cases of death of women coming later than 42 days after the cessation of pregnancy from the causes directly related to her and especially indirectly related to pregnancy (purulent-septic complications after conducting intensive therapy, decompensation of cardiovascular pathology and T . d.). Accounting for these cases and analysis of the causes of death allows you to develop a system of measures to prevent them. In this regard, the 43rd World Health Assembly session in 1990 adopted a recommendation, in accordance with which countries should consider inclusion in the death certificate of items relating to current pregnancy and pregnancy during the year, preceding death, and take the term "late Maternal death. "

Cases of death during childbirth are divided into two groups:

Death, directly related to obstetric causes: death as a result of obstetric complications, pregnancy states (i.e. pregnancy, childbirth and postpartum period), as well as as a result of interventions, omissions, improper treatment or chain of events that followed any of the listed reasons.
Death, indirectly connected with obstetric causes: death as a result of the disease that had previously had previously developed during pregnancy, out of connection with the immediate obstetric cause, but burdened by the physiological effects of pregnancy.

Along with these reasons (basic), it is advisable to analyze the random causes of death (accidents, suicide) of pregnant women, feminine and herds within 42 days after the completion of pregnancy.

The death rate during the child's birth is expressed as the ratio of the number of deaths of mothers from direct and indirect causes to the number of liveborn (per 100,000).

Death statistics for childbirth

Every year more than 200 million women in the world comes pregnancy, which has 137.6 million. End. The share of childbirth in developing countries is 86% of generics around the world, and death in childbirth is 99% of all maternal deaths in the world.

The number of deaths during childbirth per 100,000 liveborn in parts of the world differs sharply: Africa - 870, South Asia - 390, Latin America and the Caribbean countries - 190, Central America - 140, North America - 11, Europe - 36, Eastern Europe - 62, Northern Europe - 11.

In economically developed countries, low death rates are due to the high level of economic development, the sanitary culture of the population, low birth rate, high quality medical care for women. In most of these countries, childbirth is conducted in large clinics equipped with modern diagnostic and medical equipment, qualified medical personnel. For countries who have achieved the most success in the protection of women's health and children are characteristic, firstly, the complete integration of the components of the protection of motherhood and childhood and family planning, balance in their provision, financing and managing them, and secondly, the full availability of assistance in planning Families in the framework of health services. At the same time, the decline in maternal mortality was mainly achieved by improving the status of women, ensuring the protection of maternity and family planning in primary health care and the creation of a network of district hospitals and perinatal centers.

About 50 years ago, the countries of the European Region first attached the official status of pregnant women's health systems based on the usual surveys and visits to the doctor or midwife at certain intervals. With the advent of more complex laboratory and electronic technology, a large number of tests were introduced and the number of visits was changed. Today in each country of the European Region there is a legally established or recommended system of visits for pregnant women: with uncomplicated pregnancy, the number of visits varies from 4 to 30, constituting on average 12.

Death statistics for childbirth in Russia

According to the State Statistics Committee of Russia, over the past 5 years, the death rate during the birth of a child decreased by 27.2% (from 44.2% in 1999 to 31.9% in 2003 by 100 thousand born alive), and the absolute The number of maternal losses decreased by 74 cases (from 537 to 463 cases, respectively). The absolute number of deaths after abortion 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 the causes of death during childbirth in 2003 in the Russian Federation practically did not change. More than half of the maternal deaths (244 cases - 52.7%) are determined by three leading reasons: abortions (77 cases - 16.6%), bleeding (107 cases - 23.1%) and pregnancy toxicosis: 60 cases - 13 0% (Table 1.10).

From among the dead more than 7% dying aged 15-19 years (2.4% aged 15-17 years and 5% aged 18-19 years), which is 11 and 23 cases of maternal death, respectively.

Maternal mortality rate per 100,000 born in alive on federal districts (Table 1.11) fluctuates more than 2 times - from 20.7 in the North-West Federal District to 45.5 in the Far Eastern Federal District (Russian Federation 31.9). In 2003 compared with 2002, the decline in maternal mortality rate is 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 the growth of the indicator is marked 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, Karachay-Cherkess Republic, Kaliningrad and Kamchatka regions and at 7 JSC with a small number of peoples: Chukotka, Koryaksky, Committee Permytsky, Taimyr (Dolgano-Nenetsky), Evenki, Ust-Ordinsky, Buryat, Aginsky Buryat; In 13 territories, the maternal mortality rate is below 15.0; In 4 territories, the maternal mortality rate exceeds 100.0 (Nenets AO, the Republic of Mary-El, Jewish Auth. Area and Republic of Tyva).

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

The share of the died after an abortion among the total number of dead, belonging to the category of maternal mortality ranges from 3.7% in the North-West Federal District to 22.2% in the Volga Federal District (Russian Federation - 16.6%), and the maternal mortality rate After abortions per 100,000 born are alive - from 0.77 in the North-West Federal District to 9.10 in the Far Eastern Federal District (Table 1.13).

Attention is noted that with a decrease in the general indicator of maternal mortality in the Russian Federation in 2003, 5.1% was noted to reduce 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, death rate during the birth among residents of rural areas as a whole in the Russian Federation exceeds a similar indicator among residents of urban settlements: in 2000 by 1.5 times; In 2002, 1.4 times, in 2003, 1.6 times, and in three districts (South, Ural, Far Eastern) - more than 2 times. The indicator of medical mortality among the rural population in the federal districts in 2003 ranges from 30.7 in the north-west to 75.8 in the Far Eastern (Table 1.14).

There is also a difference in the structure and causes of maternal mortality. Thus, in 2003, the death rate during childbirth among residents of rural areas exceeded a similar indicator among residents of urban settlements after an abortion started and began outside the medical institution, 2.1 times, from postpartum sepsis - 2.1 times, from toxicosis Pregnancy - 1.4 times, from bleeding during pregnancy, in childbirth and postpartum period (total) - 1.3 times. Summary - from septic post-charge and postpartum complications - in 2003, each fourth of the dead, belonging to the category of maternal mortality, died.

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

The main complications caused by the anesthesiologists were:

complications of resuscitation and repeated attempts of punctures and catheterization of the connector veins;
traumatic damage to the oral cavity, larynx, pharynx, trachea, esophagus;
bronchospasm, regurgitation, Mendelssohn syndrome;
difficulties of intubation, pre-associated encephalopathy;
puncture of a solid cerebral shell in epidural anesthesia;
inadequate infusion therapy, often excessive.

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

traumatic damage to the abdominal organs;
the discrepancy of the ligature;
discaled with surgical intervention, including with extirpation of the uterus;
unconstitution of the necessary medical care.

In order to reduce deaths during childbirth among residents of the countryside, the following events are needed.

Conduct a more careful selection among rural residents threatened by maternal mortality (to establish monitoring), and direct them to the prenatal hospitalization in high-risk institutions.
Considering the high share of mortality from the postpartum sepsis, to carry out a more suspended individual approach to the early statement of the pants living in rural areas, taking into account the medical and social risks of the occurrence of purulent-septic postpartum complications, as well as to establish mandatory patronage of the parents with medical personnel of FAPs and FP (in accordance With Order No. 345 dated November 26, 1997) and to train medical staff of the primary health care diagnostics of purulent-septic postpartum complications, including early clinical manifestations of them.
Considering the greater share of abortion mortality, launched and / or begun outside the medical institution, take measures to increase the availability of artificial abortion, including abortions of a small term, at the expense of state guarantees of free medical care, and also pay special attention to the prevention of non-planable Pregnancy among rural residents and establish them as the most socially protected and low-income groups, free of charge efficient means of contraception.
Provide free travel on the transport of pregnant women and women in the postpartum period from rural areas to the level of CRH and from CRH to the level of regional (regional, republican) institutions for dispensary monitoring and, if necessary, consulting and treating in the High Risk LPU.
Provide women with high-tech and specialized gynecological help (endoscopic operations, organ-powder operations, etc.).

Prevention of death in childbirth

In recent years, the branch strategy has been built on the basis of two principles: allocating pregnant high risks of perinatal pathology and ensuring continuity in the provision of obstetric care. Much attention, which in the 70s was given perinatal risk, in the 90s it began to weaken.

Another important characteristic of help systems during pregnancy is the continuity of assistance. In Europe, a significant majority of systems consider pregnancy, childbirth, the postpartum period as three separate clinical situations requiring the use of a variety of clinical special knowledge, the use of different medical personnel and various clinical institutions. Therefore, in almost all countries there is no continuity of assistance provided during pregnancy and childbirth, i.e., a pregnant woman leads one specialist, and childbirth - another previously not observed. Moreover, the change of personnel every 8 hours of work also does not ensure the continuity and continuity of assistance and during childbirth.

In the Netherlands - a developed European country with a highly organized delivery system at home (36%) - the death rate during childbirth and newborns is the lowest. Observation of the low risk and childbirth at home are conducted by midwife and her assistant, which is assisted during childbirth and stays in the house for 10 days to help the pity.

Most European countries for the registration of communication between help during pregnancy and assistance during childbirth or physician is a standardized history of pregnancy. This document is stored in a pregnant woman who brings him to childbirth.

In Denmark, the law permits childbirth at home, but some districts achieved permission to derogate from the rule due to the lack of midwives. Births without the help of a professionally trained person are illegal in the UK and Sweden. In North America, childbirth at home without appropriate assistance is not illegal.

In the USA in 1995, death 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%), pregnant pregnant (1.2 or 16.9%), bleeding (0.9 or 12.7%), ectopic pregnancy (0.5 or 7%).

The greatest volume of prenatal assistance is accounted for by the I trimester of pregnancy.

For any family, the death of a woman with childbirth is a colossal tragedy. This is kindness for children, grief for a spouse and all close. The causes of death during childbirth can be any, but the result is one: a person is no longer returning. The record low level of maternal mortality in Russia over the past two years excellent illustrates the "Law of Large Numbers": do not fear to be pregnant, because the chances of perishing under the wheels of the car from Russians a few dozen times higher. The fear of death before childbirth or during childbirth should not be the cause of childlessness!

To begin with - some statistics concerning maternal mortality and how it is drawn up. According to the adopted method, in the statistics on maternal mortality, not only death in childbirth, the reasons for which can be the most diverse - they will be discussed below. The data includes fatal outcomes that have arrived during the period of all pregnancy and up to 42 days after delivery. Abroad, in statistics, there are cases of death of the mother after an abortion, in Russia - no.

The number of deaths for women per 100,000 births is considered the most important indicator, directly characterizing the level of development of medicine and objects in a separate country, and in such large states as Russia - and its regions. According to the Ministry of Health, in 2017 this coefficient was 7.3 per 100,000 genera, which is quite comparable with indicators in the most developed countries of the planet.

In the 33 region of the Russian Federation, zero maternal mortality recorded: This means that in 2017 there has not happened a single tragic case with a fatal outcome during childbirth.

The most common cause of death during childbirth - bleeding

Bleeding can occur both during pregnancy and during childbirth or after their completion. According to statistics, almost every fourth case of death during childbirth is associated with obstetric bleeding. The causes of acute anemia can be the following:

The placenta detachment can cause the death of the fetus and mother.
The rupture of the uterus, which occurs as a result of several reasons: a large fruit or too small lies in the manual, the neoplasms of the uterus or ovaries, the cross-position of the fetus.
Generic bleeding can begin with a non-standard separation of the latch and injuries (breaks) of the generic pathways. It is possible to serious blood loss in a very short time and, if the blood and plasma plasma is not at hand, death can come as a result of blood loss.
Blood coagulation disorders, congenital and acquired.

The danger of death due to postpartum bleeding remains within a month after childbirth. A happy mother and kid have already been discharged home, but bleeding can open a few weeks and lead to a fatal outcome. It is very important to make the most famous and close to monitor blood pressure, discharge from the vagina, pain in the stomach. If the general condition of the woman worsens without visible reasons, you need to urgently be alarming and seek help to doctors.

Obstetric sepsis

Most often arises in the postpartum period. These are infections of generic RAS and paths caused by penetration of penicillically resistant staphylococcus, various bacteria. But is it really difficult to comply with the minimum level of security in manipulation and interventions during childbirth, sterilize the tool? Even if the medical staff performs all the requirements, the cause of septic infection may be the natural microflora of the vagina, under certain conditions turning into pathogenic.

The trouble is that doctors face microbes quickly adapting to the action of modern antibiotics. Sepsis is a heavy infectious disease, it is not easy to fight him. How to reduce risks? A pregnant woman should in every way strengthen the strength of its body, which contributes to balanced nutrition and receiving vitamins. When or in water, it is worth carefully complying with all the requirements of hygiene, disinfect underwear, clothes, bedding.

Gestoses cause almost 20% deaths during childbirth

About 18% of all pregnancies in the last weeks before childbirth are accompanied by the so-called "late toxicosis". With the emergence of gestosis, disorders in hormonal regulation of organs and systems, neurosis and even genetic factor.

The development of gestosis leads to serious failures in the work of the cardiovascular system of the woman, may refuse the kidneys, necrosis of tissues occurs in the liver. The changes undergoes a placenta, which can cause oxygen starvation of the fetus with unpredictable consequences, up to the intrauterine death.

The serious flow of gestosis leads to eclampsia, when strong convulsive attacks arise. The feminine can go to whom, the attacks provoke hemorrhages, in the worst case, Eclampsia leads to the death of a woman.

Diseases "beyond" pregnancy

It is "ordinary" and well-known diseases, but they do not become less dangerous and may cause the death of women in labor. These are diseases that are not related to the reproductive function of a woman, they are called extragenital. Such reasons include diseases of the cardiovascular system (heart defects, hypertensive disease and hypotension, thrombosis and thromboembolism), diseases of the respiratory system (asthma, pneumonia), tuberculosis, kidney disease, acute appendicitis, acute pancreatitis, diabetes, epilepsy. Blood diseases can also threaten the health of the fever.

According to statistics, the extragenital diseases of the woman in acute form lead to death during childbirth in 15% of deaths.

Cusar killer. Hellp syndrome

Very complicated pathology, usually arising in the last weeks of pregnancy (very rare - in the first days after delivery) and closely connected with late toxicosis. The causes of the occurrence of HellP syndrome are reliably installed, there are several dozen hypotheses, but none is recognized as the main one. An autoimmune diseases, genetic predisposition, reception of drugs and substances, violating the activity of the liver of a woman.

Pathology Complex: Erythrocyte destruction occurs, an increase in the number of liver enzymes, platelet levels decrease, which causes a violation of blood coagulation, its concentration. Mother liver tissues are subject to destruction (hepatosis), pain symptoms are observed in the hypochondrium, pronounced friable skin. The faithful symptom of this disease is swelling, vomiting, fast fatigue.

If you do not take action on time, the woman in labor can go to whom and die: with this disease, the probability of a favorable outcome is no more than 25-35%, because no wonder hellp called the "nightmare of obstetricians." Death occurs as a result of complications: hemorrhages in the brain, thrombosis, acute hepatic insufficiency ...

The diagnosis of syndrome is produced on the basis of laboratory blood tests, ultrasound, urine analysis, computed tomography. After emergency hospitalization, if the diagnosis is set, an immediate stimulation of generic activity or an urgent caesarean section is required if natural labor is impossible for a term or state of the mother every hour deteriorating.

A boy went to the toy store and asked him to complete his passenger car. Then he stretched out the cashier toy money. Cashier laughed.
- What are you laughing? - I did not understand the baby. - The car is also not real!

Why is HELLP doctors syndrome called "nightmare"? Because in the early stages it is difficult to diagnose, especially if a doctor has a little experience or it is inattentive. The disease quickly progresses and cope with it in the later stages is very difficult.

If we take action, the life of the mother and the baby does not threaten anything, but will have to be treated in the hospital, to stabilize the blood indicators from the mother, restore the work of the liver and kidneys. The transfusion of blood and plasma is shown, various medicines are prescribed.

Death during childbirth as a result of Hellp occurs about 4% of the total number of deaths.

Death as a result of complications after surgical intervention

It is mainly a cesarean section. Like any surgical operation, Cesarean carries the risk for the guinea. Sometimes Kesarean resorted when the state of health of the woman has deteriorated significantly, or the natural childbirth turned out to be not forces.

An important advice of anesthesiologists, from which your life may depend on:before the operation of Cesarev, 8 hours before it began, it is categorically forbidden to eat anything and even drink. Carefully take advantage of the recommendations of the attending physician!

The operation itself is not too complicated, even for an inexperienced surgeon. Always ready blood and plasma for transfusion, the patient's condition is tracked using instruments, at the extreme case - near resuscitation. In the process of operation, the death of the feminine occurs extremely rarely, most cases fall into the postpartum period. Internal bleeding and complications, the slightest negligence or underwriting staff lead to tragedy, and resuscitative studies do not have time to save a woman.

Death of women in labor as a result of medical error

All causes of death during childbirth as a result of unprofessionalism or negligence of doctors can be divided into two groups:

The causes of the death of the women in labor are in the zone of responsibility of the gynecologists and obstetricians. The lack of experience and skills in the obstetrician can lead to the injuries of the women's organs. There are late decisions on the need for operational intervention, inexpressive and not fully provided medical care during childbirth and in the postpartum period.
For death in the period of childbirth, anesthesiologists and resuscitative studies are responsible. There are errors in epidural anesthesia, an overdose of infusion therapy, injury and complications in reanior measures, death may occur as a result of anaphylactic shock. According to statistics, about 7% of deaths during childbirth occurs for the reasons associated with anesthesia.

Sometimes the death of a woman is accompanied by not completely understandable circumstances, and doctors, observing corporate interests, are not always ready to recognize mistakes - because it entails criminal liability under Article 109 of the Criminal Code of the Russian Federation! Criminal cases on the occasions of the death of a woman in the maternity hospital or the death of a child with childbirth usually become public domain, these sad topics are actively covered in the press and it is difficult to deposit them.

The husband or the next relatives are obliged to apply to the police or the prosecutor's office, to achieve a fair investigation. Make it after such grief is hard, but you need. A special commission will be appointed, an independent examination was carried out, and the court will determine the perpetrators and prescribe a punishment, or justifies them if the wines in the death of a woman did not prove.

How to reduce the risk of fatal outcome?

It is impossible to insure yourself 100%, but there are still simple recommendations. First of all, during pregnancy, all the necessary surveys should be held, regularly pass tests, a doctor in women's consultation is observed. If the doctor appoints something or recommends, you need to trust him and conscientiously perform. Regular surveys will help identify hidden diseases, diagnose deviations from the normal course of pregnancy. It is necessary to carefully follow their health, well eat, avoid stress: let it be not the most important factors, but still.

Little Petya asks Little Marina:
- When we grow up, will you marry me?
- Not.
- Why?
- You see, in our family all marry their own. For example, my grandfather married my grandmother. My dad is on my mom, my uncle - on my aunt ...

The cause of death during childbirth may become untimely medical care if the woman gives birth at home. The ambulance may be late, stuck in urban traffic jams, if something went wrong. Developing with urgent help is the main argument of opponents of domestic birth, but according to statistics, death occurs at the birth of the house no more than in the most modern maternity hospital with highly qualified doctors, midwives, resuscitative.

Daily about 830 women die from preventable causes associated with pregnancy and childbirth.
99% of all cases of maternal death occurs in developing countries.
Higher maternal mortality rates are observed among women living in rural areas and among poorer communities.
The girls of adolescence are exposed to higher risk of developing complications and death as a result of pregnancy than women older age.
Thanks to qualified assistance before, during and after delivery, you can save the lives of women and newborn children.
For the period 1990-2015 Maternal mortality in the world has decreased by almost 44%.
In the period 2016-2030, in accordance with the agenda of sustainable development, the goal is to reduce the global maternal mortality rate to less than 70 per 100,000 live births.

Maternal mortality is unacceptable high. About 830 women in the world die daily from complications associated with pregnancy or childbirth. It is estimated that in 2015 approximately 303,000 women died during and after pregnancy and childbirth. Almost all these deaths occur in low-income countries, and most of them can be prevented.

In a number of countries in Africa, south of Sahara, the levels of maternal mortality have been dropped by twice since 1990. In other regions, including Asia and North Africa, even more significant progress has been achieved. Between 1990-2015 The global maternal mortality rate (that is, the number of deaths of mothers per 100,000 live births) decreased by only 2.3% per year. However, since 2000, there were higher rates of accelerated reduction in maternal mortality. In some countries, the annual reduction in maternal mortality in the period between 2000-2010. Massed above 5.5% - the level necessary to achieve the CTD.

Sustainable Development Goals and Global Women's Health Strategy and Children

Making sure to accelerate this reduction, the countries are now united around a new task - even more reduced maternal mortality. One of the tasks of the third goal of sustainable development is to reduce the global maternal mortality rate to less than 70 per 100,000 births, and no country should have a maternal mortality rate, more than twice the global average.

Where are the cases of maternal death?

High maternal mortality in some parts of the world reflects injustice in access to health care services and emphasizes a huge gap between rich and poor. Almost all cases of maternal death (99%) occur in developing countries. More than half of these cases occurs in sub-Saharan Africa and almost one third - in South Asia. More than half of the cases of maternal death occur in places with unstable conditions and humanitarian problems.

The maternal mortality rate in developing countries amounted to 239 in 2015 per 100,000 cases of birth of living children compared with 12 per 100,000 in developed countries. Between countries, significant discrepancies are noted in the indicators. There are also great discrepancies and within countries between women with high and low income and between women living in rural and urban areas.

The highest risk of maternal death threatens teenage girls under the age of 15. Complications during pregnancy and childbirth are the main cause of death among girls of adolescence in most developing countries. 2,3.

Women in developing countries have, on average, much more pregnancies compared to women in developed countries, and they are threatened with a higher risk of death in connection with pregnancy throughout life: the probability of death of a 15-year-old girl from the cause associated with motherhood is 1 at 4900 in developed countries compared with 1 to 180 in developing countries. In countries designated as unstable states, this risk is 1 to 54; This is evidence of the consequences of the destruction of health systems.

Why do women die?

Women die as a result of the development of complications during and after pregnancy and childbirth. Most of these complications develop during pregnancy and can be prevented. Other complications may exist before pregnancy, but aggravated during pregnancy, especially if they are not under observation. The main complications that lead to 75% of all cases of maternal death are the following: 4

severe bleeding (mainly postpartum bleeding);
infections (usually after delivery);
high blood pressure during pregnancy (preeclampsia and eclampsia);
postpartum complications;
unsafe abortion.

In other cases, causes are diseases such as malaria and HIV / AIDS during pregnancy, or related problems.

How can you save the life of mothers?

Most cases of maternal death can be prevented, since medical methods of preventing complications or their reference are well known. All women need access to prenatal observation during pregnancy, qualified assistance during childbirth and help and support for several weeks after childbirth. The health of the mother and health of the newborn is closely connected. It is estimated that approximately 2.7 million newborn babies died in 2015 5 and another 2.6 million were born dead 6. It is especially important that all the births are taken by qualified health workers, since timely assistance and treatment can be decisive for life and death both mother and infant. It is especially important to ensure the presence of qualified health care professionals during all kinds, since life can depend on timely assistance and treatment.

Strong postpartum bleeding: A healthy woman can die after 2 hours, if she does not have medical care. An oxytocin injection, made immediately after delivery, effectively reduces the risk of bleeding.

Infection: After childbirth, it is possible to exclude infection under adequate hygiene and when it detects its early signs and timely treatment.

Preeclampsia: It is necessary to identify and properly lead to the onset of convulsion (eclampsia) and other complications of a threat to life. Thanks to the introduction of drugs such as magnesium sulfate, it is possible to reduce the risk of developing eclampsia.

To prevent cases of maternal death, it is also vital to prevent unwanted and too early pregnancies. All women, including teenage girls, need access to contraceptive methods, as well as to secure abortion services fully allowed by law, and high-quality abortion care.

Why do mother do not get help they needed?

Poor women from remote areas with the smallest probability are gaining proper medical care. This is especially true in relation to regions with a low number of qualified health workers, such as Africa south of Sahara and South Asia. Despite the increase in the levels of prenatal observation in many parts of the world over the past decade, only 51% of women in low-income countries receive qualified assistance during childbirth. This means that millions of birth proceed in the absence of midwives, a doctor or a prepared nurse.

In countries with high income, almost all women at least four times visited women's advice in the prenatal period, they receive assistance to a qualified medical worker during childbirth and postpartum care. In 2015, in low-income countries, only 40% of all pregnant women visited women's consultation at least four times in the prenatal period.

Other factors that impede the appeal of women for medical care during pregnancy and childbirth are the following:

poverty;
distance;
lack of information;
improper service;
cultural features.

To improve maternity protection, it is necessary to identify obstacles that restrict access to qualitative services for maternity security and take measures to eliminate them at all levels of the health care system.

Activities in

Improving maternity protection is one of the main priorities of WHO. WHO is working on a decrease in maternal mortality by providing the actual clinical and software guidelines based on the actual data, establishing global standards and technical support to Member States. In addition, WHO promotes more accessible and effective treatment methods, develops training materials and guidelines for health workers, and also supports countries in conducting policies and programs and monitor progress.

In addition, WHO promotes more accessible and effective treatment methods, develops training materials and guidelines for health workers, and also supports countries in conducting policies and programs and monitor progress.

During the United Nations General Assembly in 2015, in New York, the UN Secretary-General Ban Ki-Moon announced the start of the global health strategy for women, children and adolescents for 2016-2030. 7 This strategy is a roadmap for the period after 2015, as described in sustainable development, and is aimed at terminating all preventable deaths of women, children and adolescents, as well as to create conditions in which these groups not only survive But also successfully develop and see environmental change, health and well-being.

No woman is insured against death during childbirth, it is beyond the fact that the process itself is long and painful. According to the World Health Organization, 830 women die every day due to complications during pregnancy and childbirth. Moreover, in 1990, this figure was 44% higher.

No mammal female dies so often during the work of the offspring as a person. Why do people have to pay such a high price?

Scientists believe that childbearing problems began with early members of our evolutionary branch - Hominins, who separated from other primates about seven million years ago, reports the Russian Air Force Service.

These were animals that had little to do with us, except, perhaps, the fact that already in those distant times they, like we, went on two legs. It is the stiffness that experts believed, and was the cause of the problematic continuation of childbirth. Rather, the narrowed thighs, which led to the bertonation of the generic canal, which most animals are direct.

However, in 2012, the researcher Jonathan Wells from the University College of London and his team began to study the prehistory of childbirth and came to an amazing conclusion. For most of the human evolution, the birth of a child was obvious, it was much easier. This follows from the fact that archaeologists almost do not find skeletons of babies of that period.

But the situation radically changed several thousand years ago, when people moved to a settled lifestyle. In archaeological data of the early era of agricultural societies, much more bones of newborns appear.

Increasing the mortality rate of babies at dawn Agriculture is probably a few reasons.

On the one hand, life in more densely populated groups led to an outbreak of infectious diseases to which newborns are more vulnerable. On the other hand, the diet of farmers with a high content of carbohydrates began to differ significantly from the nutrition of host hunters, in which proteins prevailed.

This affected the changes in the structure of the body: farmers, as evidenced by archaeological finds, were significantly lower than the growth of gatherers. And scientists who study childbirth, it is well known that the shape and size of the pelvis of a woman directly depends on its growth.

The smaller the growth of the woman, the less narrow hips, and therefore the agricultural revolution, obviously complicated the process of childbearing. On the other hand, the diet rich in carbohydrates influenced the fact that the babies in the womb began to gain weight faster, and a big child would give birth much more difficult.

But that's not all. Scientific evidence suggests that women's pelvis acquires the most favorable form for childbirth at the end of adolescence, when it reaches the peak of fertility, and remains such about 40 years.

In December 2016, scientists Fisher and Mittereker published a new job on the evolution of childbearing.

Previous studies assumed that large children are more chances for survival, and the birth of a baby at birth is a hereditary factor. Also, the size of the fetus depends on the size of the generic paths of the woman.

However, many children are now born with the help of cesarean sections. Therefore, Fisher and Mittereker suggest that in those societies where cesarean section is becoming popularity, babies will be born more and more.

Theoretically, the number of cases when the child is too big to be born naturally, can grow by 10-20% for only a few decades, at least in some parts of the world. Or, in other words, the body of women in these societies can evolve towards the birth of larger babies.

Most women gave birth at home - hospitals were still not widely available, and only less than 5% of women in the United States went to hospitals. Take birth helped hangup, but rich families could already afford to call a doctor. Although anesthesia already existed, it was still very rare for pain relief.

In Russia, things were about the same.

In 1897, on the celebration of the century of the Imperial Clinical Operational Institute of the Great Princess, Elena Pavlovna, its director, Lieb-Oster Dmitry Oskarovich Ott, with sadness, noted: "98% of the birthdayrs in Russia still remain without any obstetric care!"

"According to the data for 1908-1910, the number of dead under the age of 5 years amounted to almost 3/5 of the total number of dead. Especially high was the mortality rate of children at the breast "(Rashin" Russian population for 100 years. 1811-1913 ").

1910-E.

Although the majority of women still invites members of the rents (less often - doctors), in 1914 the first "maternity hospital" has already appeared. At the same time, doctors in the United States began to use the anesthetic method, which was called "Twilight Sleep" - a woman was given morphine or scopolamine. During the birth, the woman immersed in deep sleep.

The problem was that the risk of death of the mother and child in this case increased.

At the same time, 90% of doctors did not even receive formal education.

In 1913, there were only nine children's consultations throughout Russia and only 6824 beds in maternity hospitals. In major cities, the coverage of inpatient birth was only 0.6% [BME, Vol. 28, 1962]. Most women continued to traditionally give birth at home with the help of relatives and neighbors or invited an overwhelming grandmother, an obsession, and only in difficult cases - an obstetrician.

According to statistics, in the process of childbirth (mainly from sepsis and ruptures of the uterus) more than 30,000 women were dying annually. Mortality among children of the first year of life was also extremely high: 1000 born died on average 273 children. According to official data from the beginning of the 20th century, only 50 percent of Moscow residents had the possibility of obtaining professional medical care in hospital childbirth, and in general, this percentage was only 5.2% for residents of cities and 1.2% in rural areas.

World War II and the 1917 revolution that followed it slowed down the development of medicine in the country and caused degradation. The infrastructure was destroyed, and the doctors called on the front.

In Russia, after the events of October 1917, changes also occurred. The system of assistance to pregnant and women has changed primarily.

The 1918 special decree was created by the Department of Maternity and Infancy at the People's Commissariat of State Charity. This department was assigned to the main role in solving a grand task - the construction of a "new building of social protection of the upcoming generations".

1920-E.

In almost all developed countries, a real revolution in the obstetric business occurs during these years. Now the feminine has already often visited doctors who, however, considered childbirth rather "pathological process." "Normal childbirth", without the intervention of doctors, have now become a big rarity. Very often, the doctors began to apply the method of expanding the cervix, give a woman the ether in the second stage of childbirth, to make episiotomy (dissection), to use the imposition of tongs, pull out the placenta and drug to force the uterus to shrink.

Women of the USSR now has been proposed to systematically observe in women's consultations, they were prenatal patronage and early diagnosis of pregnancy pathology. The authorities struggled with "social" diseases, such as tuberculosis, syphilis and alcoholism.

In 1920, the RSFSR became the first state of the world, legalized abortion. Decree of 1920 allowed the abortion only a doctor in the hospital, for the operation there was a fairly simple desire of a woman.

In December 1920, the first meeting on the protection of motherhood and infancy makes a decision on the priority of the development of open-type agencies: nursery, consultation, dairy kitchens. Since 1924, women's consultations are starting to issue permission to free abortion.

Gradually solves the problem of training qualified personnel. His great contribution to its decision was made created in 1922 in Moscow, Kharkov, Kiev and Petrograd Institutes for the protection of maternity and infancy.

1930

In the US, the Great Depression came in these years. Already about 75% of the birth took place in hospitals. Finally, the worries began to help doctors who specialized in akin to the binding. Unfortunately, child mortality has increased from 40% to 50% - mainly due to the generic injuries that children received due to unwanted medical intervention. The Twilight Sleep Method was now used so often that almost no feminine in the United States could remember the circumstances of childbirth.

In the USSR, there is also a rollback back: the turning point was 1936, when a decision was made "On the prohibition of abortions, an increase in material assistance to women in labor, establishing state assistance to multi-semen, to expand the network of maternity homes, children's nursery and orphanages, to strengthen the punishment for non-payment of alimony and some changes in abortion legislation. "

The level of mortality since the late 1930s significantly affects the introduction of new medical technologies and drugs, in particular sulfamides and antibiotics, which make it possible to radically reduce infant mortality even during the war years.

Now the abortion was made only on medical testimony. Accordingly, underground abortions, dangerous women, became part of the USSR shadow economy. Often abortions did people who did not have any medical education at all, and the women, having received complications, were afraid to consult a doctor, because he was forced to report a crimination "where follows." If a unwanted child still appeared, sometimes he was just killed.

1940-E.

In the years following after the end of the wars, there is a sharp increase in the overall coefficients of marriage and fertility. In the United States, the birth rate in 1945 amounted to 20.4%. In the United States, the first books in defense of natural labor appear, slowly increasing the popularity of minimal interference in the process of childbearing. In the same years (in 1948), the light saw the study of the sexuality of Kinsey, who gave women the best ideas about their own reproductive system.

1950-E.

On November 23, 1955, the decree of the Presidium of the Supreme Soviet of the USSR "On the abolition of abortion" the production of an artificial interruption of pregnancy was allowed to all women and even in the absence of medical contraindications.

The decree allowed abortion in hospitals, the home abortion still remained criminalized. In this case, the doctor threatened the prison sentence to one year, and in the event of the death of the patient - up to eight years.

Separately - about the ultrasound procedure. Soviet medicine until a certain period did not have such capabilities, and the sex of the child, like many pathologies, determined "on the eye": manual inspection and listening to the abdomen with a special tube. The first ultrasound department was created on the basis of the Acoustic Institute of the USSR Academy of Sciences under the guidance of Professor L. Rosenberg In 1954, and only from the late 80s Wood began to gradually introduce into Soviet medicine.

1960-E.

In the US, the first monitoring of the frequency of fetal heartbeats appeared. Postpartum care increasingly included antibiotics, the mortality rate of the mother and the child began to fall sharply.

After childbirth, a woman in the United States finally appears the opportunity to purchase a contraceptive tablet.

1970-E.

In the Americans, in these years, there were significantly more ways to ease generic flour than women of the USSR. No less malicious methods of pain relievement, such as hypnosis, childbirth, special breath and the famous method of Lamase - the French obstetrician Fernal Lamaz as an alternative to medical intervention in the 1950s, . The main goal of the "Method of Lamase" is to increase the confidence of the mother in its ability to give birth, assistance in the elimination of painful and pain, relief of the generic process and the creation of a psychologically comfortable attitude.

M. R. Odenu owns the first publication in the scientific journal on the topic of water delivery. M. R. Oden Characterized childbirth in water as "more natural" and "close to nature" and substantiated its conclusions of the successful practice of childbirth in the Podivier clinic basin from the beginning of the 70s.

For the first time, they begin to use epidural anesthesia, which, unfortunately, slowed down almost half of the challenges.

And for the same years, pitocin is invented - a means for stimulating childbirth.

1980-E.

In the early 80s, the popularity of "Mugs" is gaining popularity in the USSR, the propagandizing fashion on the same natural childbirth: in water or at home. One of the ideological inspirations of this method was the physiologist Igor Charkovsky, who created the "Healthy Family" club. The Soviet government fought such trends.

Since the end of the 80s, the TSR procedure began to be gradually embedded in Soviet medicine, although the quality of the pictures left much to be desired.

In the early 1980s, the term of artificial interruption of pregnancy in the USSR was increased from 12 to 24 weeks. In 1987, it was possible to interrupt pregnancy, even in terms of up to 28 weeks, if there was a testimony for this: the disability of the first and second group of her husband, the death of a husband during the pregnancy of his wife, the dissolution of a marriage, a woman's stay or her husband in prison, the existence of a court decision deprivation of parental rights, multi-way, pregnancy as a result of rape.

In 1989, an outpatient interruption of pregnancy was allowed on its early timing by vacuum aspiration, that is, a mini abortion. Began to produce medication abortion.

1990-E.

The 90s is the time when doctors are looking for a balance between natural genus and medical bodies. The idea is stronger that the better mother feels, the better the baby will be.

In the mid-90s, about 21% of children appeared using cesarean sections, and the number is steadily growing.

The Times journalist writes: "The increase in the number of cesarean sections in the mid-90s was due to the increasing number of pregnant women who were appointed this procedure until the 39th week of pregnancy, even if she was not justified."

Another popular trend 90s is homework. Although the number of such practices in the United States in those days has numbered only less than 1% of all kinds, this number also began to grow.

Amnecocentsis appears - the analysis of the amniotic water, during which the puncture in the embryonic shell is made and a sample of amniotic fluid is taken. It contains the fetal cells that are suitable for testing for the presence or absence of genetic diseases.

The practice of Dul \u200b\u200b- helpers with childbirth, which provide practical, informational and psychological assistance to the Hife.

2000-E.

About 30% of childbirth take place with the help of cesarean section. The level of maternal mortality raises unexpectedly (although he, of course, is very small), which is explained by the strengthening of obesity and other medical complications.

In 2009, in the United States, the number of children born with the help of cesarean sections reached a maximum - 32.9%.

Fall this figure began only by 2011.

Some hospitals reaffirm the practice of vertical childbirth, emphasizing that they are more physiological and safe for mother and infant.

2010-E.

Vertical childbirth - no more exotic. For example, Moscow Maternity Mountain House No. 4 argues that they "are actively implementing an alternative method of labor process in the vertical position of the feminine. Today, vertical clans are 60-65% in relation to the total number. "

National associations dasy appear in Russia and Ukraine, more and more often women give birth to her husband or partner.

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