In the last issue of Urology Digest N3-2016, we looked at the issue of maternal mortality. Infant mortality has always been considered a “sensitive barometer” of the social well-being of society, according to the level of which, as well as in terms of life expectancy, the general health and quality of life of the population and the level of socio-economic development and well-being of society as a whole are assessed. Together with the level of maternal mortality, it indicates the state of the reproductive health of the population, as well as the state of obstetric services and pediatrics.

Statistics

Infant mortality characterizes the mortality of children in the first year of life. Mortality under the age of 1 year is much higher than the mortality rate at most ages: its probability during this period of time is comparable to the probability of death of persons who have reached 55 years of age. At the same time, as noted by the WHO, newborns account for 40% of all deaths of children under the age of five. The majority of all neonatal deaths (75%) occur in the first week of life, and 25-45% of these occur within the first 24 hours.

According to the WHO classification, there is the following distribution of the periods of infant mortality (Fig. 1):

Infant mortality characterizes the mortality of children in the first year of life. Mortality under the age of 1 year is much higher than the mortality rate at most ages: its probability during this period of time is comparable to the probability of death of persons who have reached 55 years of age. At the same time, as noted by the WHO, newborns account for 40% of all deaths of children under the age of five. The majority of all neonatal deaths (75%) occur in the first week of life, and 25-45% of these occur within the first 24 hours. According to the WHO classification, there is the following distribution of the periods of infant mortality (Fig. 1): the perinatal period (from 22 weeks of gestation to 7 days of life (including the early neonatal - from the moment of live birth to 7 days) - given that when calculating directly neonatal mortality, the denominator contains only born alive, and perinatal - all births, including stillborns) late neonatal period (from 8 to 28 days of life) postneonatal period (until the end of 1 year of life)

In addition, the period from 1 year of life to reaching 5 years of age, when death is classified as "infant mortality", is separately distinguished.

Fig. 1. Terminology for the classification of deaths during pregnancy and early childhood

Calculation of indicators

Algorithms for calculating the infant mortality rate:

The formula adopted by the state statistics bodies in the Russian Federation (Fig. 2):

However, due to the fact that a child can be born in one calendar year (for example, in December 2015), and die in another calendar year (for example, in January 2016), the following calculation method is also used to determine the indicator. 3): Order of the Ministry of Health and Social Development of the Russian Federation of December 26, 2008 N 782n "On the approval and procedure for maintaining medical documentation certifying cases of birth and death" documents for registering infant mortality approved the "Medical certificate of death" (f. 106 / u-08) and "Medical certificate of perinatal death" (f. 106-2 / u-08).

Fig. 2. Algorithm for calculating the infant mortality rate, adopted in the state statistics bodies of the Russian Federation

Fig. 3. The WHO algorithm for calculating the infant mortality rate according to the Rats formula

Dynamics in Russia

According to the latest data, in the first half of 2015, the infant mortality rate in Russia reached 6.6 per 1000 live births. Taking into account that this indicator is only half a year, the coefficient is really high. As the head of the Health Foundation Eduard Gavrilov notes, "... there was no such increase in infant mortality even during the economic crisis of 2008 and in subsequent years."

It should be noted that the dynamics of changes in the infant mortality rate in the Russian Federation is still not stable. In different periods of time, the Federal State Statistics Service of the Russian Federation notes both its decrease and increase (Fig. 4).

Fig. 4. Dynamics of changes in the infant mortality rate in the Russian Federation in the period 2008-2014.

For example, in 2014 the infant mortality rate was 7.4 per 1000, which is lower than the figure for 2013 - 8.2 per 1000 live births. At the same time, as the deputy director for scientific work of the FGBU Scientific Center for Obstetrics, Gynecology and Perinatology named after V.I. IN AND. Kulakova Dmitry Degtyarev, the decline in infant mortality rates is never synchronous in all regions. Thus, in the first half of 2013, infant mortality rates higher than the national average were observed in 25 regions (30.11%), in the first half of 2014 - in 16 (18.8%), and in the first half of 2015, an increase in infant mortality rates was observed. mortality rates were higher than the national average in 20 out of 85 regions, amounting to 23.5%.

Fig. 5. Distribution by indicators of infant mortality in the Russian Federation, depending on the place of residence

The indicator of infant mortality also differs depending on the residence of the woman in labor in the city or in the countryside (Fig. 5). As in the case with the statistics of the Federal State Statistics Service of the Russian Federation on maternal mortality, mortality rates among the rural population exceed those among the urban population.

Infant mortality by regions of the Russian Federation

As noted above, infant mortality rates are also different by region. According to the Federal State Statistics Service of the Russian Federation on infant mortality in the constituent entities of the Russian Federation for the period January-December 2015, the districts with the highest infant mortality rate are the North Caucasian Federal (11.9 ‰ for 2014 and 10.3 ‰ for 2015) and Far Eastern Federal (9.1 ‰ for 2014 and 7.6 ‰ for 2015). The districts by the lowest indicator are Volga Federal (7.2 for 2014 and 6.1 ‰ for 2015) and Northwestern Federal - (5.8 ‰ for 2014 and 5.3 ‰ for 2015) ( fig. 6)

Fig. 6. Infant mortality in the constituent entities of the Russian Federation in 2014 and 2015.

Periods of infant mortality

Within the framework of the first year of human life, which considers the infant mortality rate, three periods are distinguished, differing both in the probability of death and in the structure of the dominant pathology.

The perinatal period is the period from the 22nd week of pregnancy to the end of the 7th day of extrauterine life. Separately, it distinguishes the intranatal period (from the time of the appearance of regular labor pains to the moment of cord ligation - 6-8 hours) and the early neonatal periods (from the moment of live birth to 7 days of life). Difference: when calculating neonatal mortality, the denominator includes only those born alive, when calculating perinatal mortality - including stillborns. This period is the most important time in the life of the fetus and the newborn, with the highest risk of death (taking into account that it includes children born prematurely). It accounts for up to 75% of deaths in the first year of life and up to 40% of all infant deaths under 5 years of age. The value of this indicator - especially in interregional and interstate comparisons - characterizes the level of the mother's reproductive health, her quality of life, the state of obstetrics and many other aspects of medical and social development. It is also believed that, with sharp fluctuations in the indicator, the dynamics of perinatal mortality indicates distortions in the statistical accounting of infant mortality, since the number of deaths during this period correlates with the total number of births - both living and dead.

Since 2012, the Russian Federation has switched to birth registration according to WHO criteria (gestational age 22 weeks or more, body weight at birth of a child 500 g or more or less 500 g in case of multiple births; body length of a child at birth 25 cm or more in case of if the baby's birth weight is unknown). Caring for these children is a new level of complexity and directs the search for solutions to reduce fetal loss, neonatal disability and infant mortality.

The causes of infant mortality in the perinatal period are usually divided into two groups:

1. diseases or condition of the mother or placenta, pathology of pregnancy and childbirth;
2. diseases and condition of the fetus

The first group of reasons includes complications from the placenta, umbilical cord and membranes - premature placental abruption, umbilical cord pathology, etc.; complications of pregnancy such as toxicosis in the second half of pregnancy, premature rupture of amniotic fluid; direct complications of childbirth and delivery.

The causes of perinatal mortality from a child in developing countries are: 22.5% each - asphyxia and birth trauma, 12.7% - congenital malformations, 1.4% - infections. Developed countries have a higher proportion of congenital anomalies and a lower proportion of intrapartum causes and infections.

The neonatal period is the period of a child's life from the moment of birth until he reaches 28 days. Within the framework of the neonatal period, two are distinguished: early (1st week of life) and late (2nd - 4th weeks), which correspond to the concepts and indicators of early and late neonatal mortality.

The main causes of neonatal mortality are: congenital malformations, birth trauma, pneumonia of newborns (excluding congenital). The ratio of these reasons differs depending on the standard of living and the state of health care in terms of obstetrics. A fundamental feature of infant mortality in Russia, which qualitatively distinguishes it from the EU indicators, is a steady downward trend in the proportion of neonatal mortality in favor of an increase in postneonatal mortality. This feature of the dynamics of the indicator is due to the so-called. "Under-registration" of dead newborns. The main ways of underestimating the infant mortality rate are the “transfer” of dead children to stillbirths, which are not accounted for in state statistics, or the attribution of a deceased child to unregistered “fetuses” (“miscarriages”, which in domestic medicine - up to 2011 inclusively - included termination of pregnancy up to 27 complete weeks). In practice, these two "mechanisms" are revealed on the basis of obvious structural disproportions in the number of live and stillborns, as well as on the dissociation of the weight structure of the dead - the disappearance of children of borderline body weight (1000-1499g), "thrown" into unregistered "fetuses".

The third period, which stands out within the first year of life, is postneonatal - from the 29th day of life until reaching 1 year, for which the corresponding postneonatal mortality rate is calculated. Among the main causes of postneonatal mortality are congenital anomalies, respiratory diseases, and external causes. The latter include the quality of care and nutrition, the timeliness of the provision of pediatric care, and trauma.

Dynamics - historical facts

The past century has been marked by a significant decrease in infant mortality throughout the world. If at the beginning of the twentieth century. in Norway, every twelfth to thirteenth newborn died before a year, in France - every seventh, in Germany - every fifth, in Russia - every fourth, then in the period from the middle to the end of the twentieth century. infant mortality rates have dropped dramatically.

However, the changes occurred with varying degrees of success. At the beginning of the XX century. infant mortality rates in Russia were extremely high: in 1901, the proportion of deaths at this age was 40.5%, gradually decreasing to 38% in 1910. During this period, Russian indicators exceeded the corresponding data in developed countries by 1.5-3 times. The main causes of infant mortality at the beginning of the XX century. there were gastrointestinal and infectious diseases, respiratory diseases. In many ways, such a high level was associated with the peculiarities of breastfeeding in Russian families, where it was traditionally customary almost from the first days of life to give the child complementary foods or completely deprive him of breast milk, leave him without a mother in the care of adolescents or the elderly. ...

Also, the reasons for the high mortality were the underdevelopment of the system of medical care and obstetrics, the difficult sanitary environment of work, life and living conditions, lack of knowledge of hygiene, and low literacy of the population. In Russia, there was no legislation on the protection of mothers and children, which had existed in many European countries for a long time. In the 1920s. as a result of health care reforms on the adoption and implementation of legislation and decrees on the protection of mothers and children, on the development of a system of obstetrics and medical care for mothers and children, on the creation of infrastructure for childcare (dairy kitchens, nurseries, foster care system, infant shelters) , on carrying out sanitary and educational work as an integral part of the cultural revolution, a decrease in infant and maternal mortality was achieved. In 1926, the Russian mortality rate for children under 1 year old was 188 per 1,000 births, that is, in the first quarter of the 20th century, it decreased by almost a third.

1930s characterized again by fluctuations in the level of infant mortality due to influencing economic and social reasons. The NEP was curtailing, the process of industrialization and collectivization of agriculture began, which contributed to the growth of indicators to the level of the first decade of the XX century. In 1933, the highest infant mortality rate was reached - 295.1 ‰ - largely due to the mass hunger of the population, and only by the end of the 1930s. began to decrease steadily again. The main reason for this was the implementation of measures to protect motherhood and childhood, the growth of health literacy of the population, and the improvement in the quality of medical care.

After the Great Patriotic War, the indicators improved again. First of all, this is due to the emergence and use of antibiotics and sulfa drugs in the treatment of gastrointestinal infections and pneumonia, which led to a significant reduction in the mortality of children under 1 year of age from respiratory diseases and infectious diseases. As a result, in 1946, the infant mortality rate in Russia amounted to 124.0 ‰, compared with 205.2 ‰ in 1940, and by the mid-1960s. mortality in the first year of life decreased in the country by another 5 times: to 26.6 ‰ in 1965.

The reduction in infant mortality continued in the future. From the 1960s to the end of the twentieth century. its level has decreased by 2.5 times. However, this decline was repeatedly interrupted by periods of increase: in 1971-1976, 1984, 1987, 1990-1993 and 1999. The growth of the indicator in 1990-1993 was significant. from 17.4 to 19.9 ‰, which is associated with the transition from January 1, 1993 to the WHO-recommended definitions of live birth.

At the 1990 World Summit for Children, the first of the agreed targets was to substantially reduce the mortality rate of infants and children under 5 years of age. Subsequently, significant emphasis was placed on this in the commitments made in the final document "A world fit for children" during the special session of the UN General Assembly on the situation of children in 2002. In addition, since 2000, the reduction of child mortality by 2/3 by 2015 was included in the list of the UN Millennium Development Goals. And, according to the published 2015 MDG report, the under-five mortality rate globally fell by more than half, falling from 90 to 43 deaths per 1,000 live births between 1990 and 2015.

At present, as mentioned at the beginning of this work, infant mortality rates are not stable, but compared to the 20th century. the dynamics are definitely positive. According to the Federal State Statistics Service of the Russian Federation in 2014, the infant mortality rate will be 7.4, although the indicators for 2015, judging by the data for the first half of the year, are likely to be higher. In accordance with the analysis of existing problems to reduce infant mortality, which is one of the goals of the "Strategy for the development of healthcare in the Russian Federation until 2020", the following provisions can be put forward:

• ensuring equal access to highly qualified specialized care regardless of living in urban or rural areas through regionalization of assistance;
• level system of perinatal care
• expanding the network of perinatal centers with the ability to provide optimal care for seriously ill and extremely immature premature babies
• ensuring equal access to high-tech care for high-risk pregnant women and women in labor;
• ensuring a full examination of potential parents for congenital diseases and possible pathologies of the future fetus;
• improving the quality and regularity of observation of pregnant women for timely referral to institutions of the required functional level, corresponding to the state of health of the woman, the state of the fetus, the nature of the course of pregnancy and the expected timing of delivery;
• monitoring the effectiveness and timeliness of hospitalization in compliance with the principles of regionalization; development of an emergency transport service for pregnant women, women in labor and newborns;
• provision of conditions for continuing medical education and professional development of personnel;
• a comprehensive analysis of the causes of perinatal mortality (including stillbirths) separately for term and premature babies in order to identify the existing reserves for reducing perinatal losses;
• improving the reproductive education of Russian youth and developing an appropriate mentality for future parents based on a responsible attitude to their own health.

M.P. Perova
Member of the Association of Medical Journalists

Perinatal period- starts from the 22nd full week (154th day) of intrauterine life of the fetus (at this time, the normal body weight of the fetus is 500 g) and ends 7 full days after birth (0-6 days).

To take into account the causes of perinatal mortality in international practice, the “Certificate of the cause of perinatal death.

In the European Region, the perinatal mortality rate ranges from 5 to 20, including in Belarus the perinatal mortality rate is 5.3
(2005 year).

The demographic indicators that specify the overall mortality rate include maternal mortality. Due to its low level, it does not have a noticeable effect on the demographic situation, however, it fully reflects the system of health care for women and children in the region.

Maternal mortality (MS) by WHO- caused by pregnancy, regardless of the duration and location, the death of a woman that occurred during pregnancy or within 42 days after its termination from any cause associated with pregnancy, aggravated by her or her management, but not from an accident or an accidental cause ... In accordance with the ICD, it is calculated per 1000 live births. However, WHO, taking into account the small number of deaths in developed countries and, accordingly, the insignificant value of the indicator per 1000 live births, in statistical indicators, calculates per 100,000 live births.

In developing countries, MS can reach 600-1500 per 100,000, in economically developed countries it usually does not exceed 10 per 100,000, in Belarus in 2004 - 17.9 per 100,000 live births.

MC groups: a) for reasons related to obstetrics; b) indirectly due to obstetric reasons.

The structure of the causes of MS: most (about 80%) are obstetric (most often: ectopic pregnancy, bleeding, abortions of extracurricular institutions), 20% are causes indirectly associated with pregnancy and childbirth (extragenital diseases).

46. ​​Maternal mortality. Methods for calculating the indicator. The level and causes of maternal mortality in the Republic of Belarus and the world.

Strengthening the intensity of observation, the staging of medical care, the integration of the functions of district doctors of various health organizations of the complex at each stage requires the development of successive acts of observation of a woman and a child in the "mother-fetus-child" system. Such a sequence of acts of observation in order to facilitate the practical use of the proposed system of organizational measures to protect the health of women and children in the conditions of ATPK can be presented in the form of an algorithm, which is divided into several successive stages.

The first stage is preventive health care of this child at the stage preceding conception.

The second stage is the organizational actions of the doctors of the three networks during the intrauterine life of the child. At this stage, the identification of risk factors for perinatal pathology is carried out together with the doctors of the three networks; assessment of medical and social conditions for the possibility of continuing the intrauterine development of the fetus; planning the continuation of intrauterine development of the fetus.

The third stage is the organizational actions of doctors of three specialties at the stationary stage, combining the period of prenatal preparation, intrapartum and postnatal periods. At this stage, continuity is ensured in monitoring the fetus (child) between outpatient (antenatal), inpatient (intranatal, postnatal) and outpatient (neonatal) periods of life.

The fourth stage is organizational measures that ensure the protection of the child's health from the moment of admission to the children's clinic until the age of one year.

The fifth stage - organizational measures to ensure the protection of the health of a child from one to 18 years old.

The World Health Organization defines maternal mortality as caused by pregnancy, regardless of the duration and location, the death of a woman that occurs 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.

Maternal deaths are divided into two groups

1. Death directly related to obstetric causes, ie. death as a result of obstetric complications of pregnancy, childbirth, the postpartum period, as well as as a result of interventions, neglect, inappropriate treatment or a chain of events following any of the listed causes.

2. Death indirectly related to obstetric causes, ie. death as a result of a preexisting illness or illness that arose during pregnancy, unrelated to the direct obstetric cause, but aggravated by the physiological effects of pregnancy.

This indicator makes it possible to assess all the losses of pregnant women (from abortions, ectopic pregnancy, from obstetric pathology and EHP during the entire gestational period), women in labor, parturient women within 42 days after the end of pregnancy.

The indicator should be calculated at the level of the city, region, country. Analysis of maternal mortality (MS) should be carried out at each level of care.

In accordance with ICD-10, the MC indicator should be calculated per 1000 children born alive. However, WHO, taking into account the small number of deaths in developed countries and, accordingly, the insignificant value of the indicator per 1000 live births, in statistical indicators, calculates per 100,000 live births.

Indicators of the structure of the causes of MS determine the role and significance of each disease in the total set of causes, i.e. allow to establish the place of a particular cause of death among all deceased women.

Along with the definition of the structure of MS, it is very important to calculate the intensive mortality rate from individual causes.

Calculation of the indicator of maternal mortality

Calculation of the structure of the causes of maternal mortality

Natural movement of the population, factors influencing it. Study methods. Indicators, calculation method.

Natural movement of the population - a change in the size and composition of the population as a result of the processes of fertility and mortality. It is characterized by indicators of fertility, mortality, natural (relative and absolute) growth, life expectancy at birth.

Natural growth- can be expressed as an absolute number as the difference between the number of births and the number of deaths over a certain period of time (more often for 1 year) or the rate of natural growth (CEP).

KEP = fertility rate - death rate

In RB = -5.3
.

Natural population growth does not always reflect the demographic situation in society, because the same growth parameters can be obtained for different fertility and mortality rates. Therefore, natural population growth should be assessed only in relation to fertility and mortality rates. A high natural increase can be considered as a favorable demographic phenomenon only with a low mortality rate.

A high growth rate with a high mortality rate characterizes an unfavorable situation with the reproduction of the population, despite the relatively high birth rate. A low growth rate with a high mortality rate indicates an unfavorable demographic situation. A negative natural increase in all cases indicates a clear disadvantage in society and is typical for a period of wars, economic crises. A negative natural increase is an unnatural decline in the population.

Since 1993, the Republic of Belarus has celebrated negative natural growth, which leads to a reduction in the resident population of the country.

Basic laws of natural movement in Belarus: the demographic situation in Belarus is characterized by depopulation, which is a state problem.

Factors affecting natural growth, - factors affecting mortality and fertility.

One of the indicators used to assess public health is life expectancy indicator (average life expectancy)- the hypothetical number of years that a given generation of births or the number of peers of a certain age will have to live, provided that throughout their life the mortality rate in each age group will be the same as it was in the year for which the calculation was made. This indicator is more objective than the indicator of general mortality and natural population growth, characterizes the viability of the population as a whole and is suitable for dynamic analysis and comparison of data across different countries. It is impossible to equate the indicator of life expectancy with the average age of the deceased and the average age of the population.

To calculate the indicator, age-specific mortality rates are used by constructing life tables (or life expectancy). Life expectancy is calculated differentially for men and women.

The problem of significantly lower life expectancy for men in comparison with women is becoming more serious every year. At the end of the 1960s, these differences were insignificant, and by 2005 the difference reached 12 years (in the republic, the life expectancy of women was 74.9 years, for men - 63 years).

Medical rehabilitation: definition of the concept, stages, principles. Medical Rehabilitation Service in the Republic of Belarus.

Medical rehabilitation- a process aimed at restoring and compensating by medical and other methods of the functional capabilities of the human body, impaired as a result of a congenital defect, past diseases or injuries

The main goal of medical rehabilitation is to prevent disability, restore and prolong active life, social integration and ensure an acceptable quality of life. The maximum task is to achieve the full level of social and domestic services; the minimum task is to increase the patient's ability to self-care.

Principles of medical rehabilitation:

a) early onset;

b) continuity;

c) stages (stationary stage, outpatient stage and sanatorium-resort stage);

d) continuity;

e) the complex nature of rehabilitation;

f) an individual approach.

Integration of rehabilitation in the treatment process;

Establishment of a medical rehabilitation service (since 1993), 2 types of institutions:

Non-specialized (they are organized at the regional level, these are multidisciplinary departments of medical rehabilitation);

Specialized (at the regional and republican level, created according to nosology).

Levels and services of medical rehabilitation in Belarus:

1) Republican level:

Rehabilitation department with a clinic on the basis of the Belarusian Scientific Research Institute for the examination of the working capacity and organization of work of disabled people

Specialized rehabilitation centers based on clinical research institutes

2) Regional level:

Regional multidisciplinary departments of medical rehabilitation on the basis of the regional hospital

Specialized rehabilitation beds in departments

Rehabilitation beds on the basis of dispensaries

Medical and preventive rehabilitation rooms.

3) Local level: non-specialized medical rehabilitation departments.

Stages of medical rehabilitation:

1) medical and rehabilitation

2) stationary - in specialized stationary departments

3) outpatient clinical

4) inpatient late medical rehabilitation.

Family planning. Definition, contemporary problems. Medical organizations and family planning services in the Republic of Belarus.

Family planning- a set of medical and social measures aimed at reducing morbidity, mortality, maintaining the health of the population in order to give birth to healthy and desired children.

Planning principles:

Prevention of unwanted pregnancy in women under 19 and after 35-40 years

Compliance with the intervals between childbirth 2.0-2.5 years

Prevention of abortions in women at risk (in 2001, the Republic of Belarus issued a decree on a list of medical indications for termination of pregnancy (15 indications) + a list of social indications (10 indications)

Sexual education for adolescents

Premarital counseling

Widespread introduction into practice of modern methods of contraception in order to improve pregnancy planning

Family planning institutions:

1. Women's consultation

2. Medical genetic consultation

3. Consultation marriage and family

4. Republican Scientific and Practical Center "Mother and Child"

Modern problems of family planning:

1) a decrease in the birth rate to the level of few children (there are often 1-2 children in a family, which does not ensure simple reproduction of the population)

2) dangerous interruptions of pregnancies (especially the first), leading in the future to infertility, miscarriage, inflammatory processes (after abortion, complications during pregnancy and childbirth are 3 times more common), an increase in the frequency of oncology (abortion in women 20-24 years of age increases the incidence of breast cancer by 2 times).

3) non-observance of the proper interval of 2.0-2.5 years between births (children born with an interval between pregnancies of 1 year die 2 times more often than children born with an interval of 2 or more years)

4) early onset of sexual activity (direct relationship between early onset of sexual activity before the age of 19, especially with many partners, and the incidence of cervical cancer).

Planning Service Objectives:

Family planning training for physicians and nurses

Guided hygienic education in family planning

Strengthening the health status of the population, treating diseases, solving issues and problems

Planning Service Tasks:

Prevention of unwanted pregnancy, treatment of infertility and sexually transmitted diseases

Prevention of early and late birth

Ensuring optimal birth spacing

Life expectancy: definition, trends in the Republic of Belarus and in the world.

The generalized public health indicator is life expectancy at birth (Life expectancy at birth).

Life expectancy is the number of years that a given generation of births (or the number of peers of a certain age) will have to live on average, if we assume that throughout its life the mortality rate will be equal to the present mortality rate of the population in certain age groups. Those. provided that when moving from one age group to the next, the mortality rate will remain the same as it was in the years of compilation of the life table.

By each subsequent age, fewer and fewer people remain due to extinction. Mortality (or survival) tables show the order (sequence) of extinction for a population of people born at the same time. Knowing the age-specific mortality, you can calculate the probability of living to a certain age. It will be the difference between the number of those who survived to a certain age and the number of deaths during a certain period (1, 5, 10 years), i.e. the number of deaths up to the next age group.

The official threshold for longevity (age, profession, etc.) is 90 years. Long-livers are characterized by their own lifestyle and dietary habits. In the Caucasus, for example, these are apricots, grapes, vegetables, honey, i.e. fortified foods, vegetable oil, sour milk (matsuku). Most of the centenarians do not smoke. Sleep for 8-10 hours, i.e. sleep well. Have a hobby. Her favorite pastime is raising grandchildren and great-grandchildren. They avoid selfishness, stinginess, grumpiness. Besides - labor, clean air, spring water, good heredity. Among long-livers, blue-eyed predominate, 42% of them.

According to the analysis of demographic data, by the end of the century, the average age of the world's inhabitants will rise to 26 years. Today it is 23.5 years old.

Life expectancy in different countries of the world is: in the UK 72-78 years; USA 72-79 years old; Japan 76-82 years old; Mexico 68-74 years old.

Life expectancy at birth in the WHO European Region:

Austria 78.9

Albania 75.8

Belgium 77.6

Bulgaria 72.4

Hungary 72.6

Germany 78.8

Greece 79.0

Denmark 77.2

Israel 79.7

Spain 79.8

Italy 80.3

Kazakhstan 65.9

Latvia 71.0

Lithuania 72.2

Poland 74.7

Republic of Moldova 68.1

Russian Federation 64.9

Ukraine 67.8

Switzerland 80.5

Sweden 80.0

In the Republic of Belarus, in comparison with developed countries, this indicator is 12-14 years lower for men and 5-6 years for women.

an increase in the total fertility rate to 10-11 per 1000 people;

an increase in the total fertility rate (the number of children whom one woman could give birth to throughout the entire reproductive period (15-49 years) to 1.5;

reduction of the general mortality rate to 10-11 per 1000 population;

reduction of infant mortality to 6.0 per 1000 live births;

decrease in mortality from socially significant diseases by 8% per year;

achieving by 2011 life expectancy at birth (life expectancy) 70–72 years;

ensuring an annual population growth of 5 thousand people due to external migration of mainly qualified labor force of working age.

During the period of the program, out of 6 expected results of its implementation, 5 of which are within the competence of the Ministry of Health, 4 completed:

The birth rate increased by 23.9% - from 9.2 ‰ in 2005 to 11.4 ‰ in 2010 (according to the program - 10-11 per 1000 people).

The infant mortality rate by 2010 has been reduced to 4.0 ‰ (under the program - below 6 ‰).

The total fertility rate increased to 1.44 (according to the program - 1.4 - 1.5).

The indicator of life expectancy at birth of 70-72 years (annual indicator) was also fulfilled and amounted to 70.5 years.

The indicator of the reduction of the general mortality rate of the population from all causes to 10-11 per 1000 people envisaged by the program has not been fulfilled; in 2010 the overall mortality rate was 14.5 per 1000 population (in 2005 the total mortality rate was 14.5).

Failure to meet this indicator is due, first of all, to an increase in the number of elderly people in the structure of the population, so when comparing the share of population groups in the total number of deaths, it was revealed that the share of people:

under working age decreased by 33.3% (from 0.9% in 2005 to 0.6% in 2010);

working age decreased by 5.2% (from 24.8% in 2005 to 23.4% in 2010);

and over working age - increased by 2.2% (from 74.3% in 2005 to 76% in 2010)

In terms of life expectancy, Belarus is in the 109th place among 192 countries in the world. Having overtaken all the states of the post-Soviet space by increase, and substantially.

Note that with the aging of the nation, that is, with an increase in average life expectancy, the number of cardiological and oncological diseases will only increase. By 2020, 70 thousand cancer patients will be identified annually.

Belarusians live almost 12 years longer than Belarusians, in rural areas the situation is even more significant. Whereas the biological difference is only 2-3 years.

Different lifestyles: men abuse their bad habits more and are less careful about their health. Natural destination is more important in women than in men.

Morbidity as a medical and social problem. Modern trends and features in the Republic of Belarus and in the world.

Morbidity- a phenomenon that characterizes the state of health of the population; a set of diseases identified and registered among the population as a whole or its individual groups for a certain period of time.

Medical and social significance of morbidity:

1) the levels and structure of morbidity are the most important components in a comprehensive assessment of health, a criterion of public health

2) determines the level of disability and mortality

3) on the basis of morbidity data, planning of preventive measures and programs at the state and regional levels is carried out

4) on its basis, the need for staffing and various types of assistance is determined

5) are used as criteria for evaluating the work of institutions and doctors

Conditions required for conducting morbidity studies:

1) application of unified terminology

2) use of standard nomenclatures and classifications

3) uniform methods of collecting information

4) calculation of morbidity indicators using uniform formulas.

Terminology of morbidity.

Primary morbidity- the aggregate number of new diseases, which have not been accounted for anywhere before and for the first time in a given calendar year, detected and registered among the population of diseases, calculated for 100 thousand populations.

General morbidity- the aggregate of all diseases present in the population, both newly diagnosed in a given calendar year, and registered in previous years, for which the patients turned again in a given year.

Cumulative incidence is the aggregate of all primary diseases registered over a number of years (at least 3 years).

Pathological affection- a set of all pathological conditions (acute and chronic, premorbid conditions) identified during one-time examinations and preventive examinations.

Patient contingent- the number of persons registered at a certain point in time for each disease.

Modern trends and peculiarities of morbidity in the Republic of Belarus.

1) the level of general morbidity in the Republic of Belarus in 2005 was 130,000 per 100 thousand of the population, the primary incidence in the Republic of Belarus in 2005 was 74,000 per 100 thousand.

2) the presence of differences in the morbidity of the urban and rural population - the rural population has a reduced number of visits to a doctor, it is located far away, the incidence rate is incomplete, the level of doctors is lower in the village, the incidence in the village is lower.

3) the incidence depends on age, after 16 years - an increase in the incidence rate, by the age of 60 - a high level and further increases.

4) the incidence depends on gender (in women - more often endocrine, in men - stomach ulcer, myocardial infarction)

5) different structure of primary and general morbidity + SEE QUESTION 30

Maternal, child and perinatal mortality

NATURAL POPULATION MOVEMENT

The natural movement of the population is considered as a set of processes of birth rate, mortality and natural growth, ensuring the renewal and change of generations. The main indicators of the natural movement of the population are:

Fertility;

Mortality;

Natural increase (unnatural decline) of the population;

Life expectancy at birth.

Fertility

Under fertility understand the natural process of population renewal, characterized by the statistically recorded number of births in a particular population over a certain period of time.

According to Russian legislation, all children within 1 month from the date of birth must be registered with the registry office at their place of birth or at the place of residence of their parents. The main document for registering a child with the registry office is the "Medical birth certificate" (f. 103 / u-08). It is issued when the mother is discharged from the hospital by all health care institutions in which the birth took place, in all cases of live birth. In the case of home delivery, the "Medical Birth Certificate" is issued by the institution where the mother is delivered after delivery. In case of multiple births, the "Medical Birth Certificate" is filled in for each child separately.

In settlements in medical institutions where doctors work, the "Medical Birth Certificate" must be filled in by a doctor. In rural areas, in health care facilities that do not have doctors, it can be issued by the midwife or paramedic who took the birth.

In the event of a stillbirth or death of a child in a maternity hospital, the "Medical birth certificate" must be completed, which is provided together with the "Medical certificate of perinatal death" (f. 106-2 / u-08) to the registry office.

A record on the issuance of a "Medical birth certificate" with an indication of its number and date of issue must be made in the "History of the development of a newborn" (f. 097 / y), in the case of a stillbirth - in the "History of childbirth" (f. 096 / y). To take into account fertility, calculate a number of demographic indicators, it is extremely important to determine whether a child was born alive or dead, gestational age, full-term fetus, etc.

For statistical analysis of fertility, the total fertility rate and special fertility rates are used.

The simplest and most widely used is total fertility rate,

To estimate the total fertility rate, it is advisable to use the scheme shown in Table. 2.1.

Table 2.1. Scheme for estimating the total fertility rate

Speaking about fertility in human society, it should be remembered that it is determined not only by biological (as in the animal kingdom), but above all by socio-economic conditions of life, ethnic traditions, religious attitudes and other factors. The total fertility rate depends on a number of demographic characteristics and, first of all, on the age-sex structure of the population, therefore it gives only the very first, approximate idea of ​​the birth rate.

To eliminate the influence of demographic characteristics, indicators are calculated that clarify the birth rate, in particular special fertility rate (fertility). When calculating this coefficient, in contrast to the fertility rate, the denominator is not the total population, but the number of women aged 15-49 years. This age interval is called a woman's generative, fertile or fertile period. It should be borne in mind that when calculating the special fertility rate (fertility), all children born to mothers under the age of 15 and 50 years and older are indicated in the numerator.

The special fertility rate (fertility) is calculated by the formula:

The special fertility rate (fertility), in turn, is being specified age-specific fertility (fertility) rates, for which the entire generative period of women is conventionally divided into separate age intervals (15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49 years) and for each interval they calculate their own indicator, moreover, the numerator indicates the number of live-born children in women of this particular age. For example, the age-specific fertility (fertility) rate for women aged 20-24 is calculated using the formula:

Age-specific fertility (fertility) rates make it possible to analyze the level and dynamics of the intensity of fertility regardless of the age structure of women of reproductive age. This is their advantage. At the same time, their large number (taking into account the number of age intervals) significantly complicates the analysis. To eliminate this drawback, one calculates total fertility rate, or fertility rate.

The total fertility rate (fertility) characterizes the average number of births per woman throughout the entire reproductive period, while maintaining the existing levels of fertility at each age. The indicator is calculated by the formula:

The total fertility rate above 4.0 is considered high, below 2.15 - low. To ensure simple reproduction of the population (without increasing its size), this indicator should be at least 2.2.

In demographic statistics, the concepts of "live birth", "stillbirth", "perinatal period", as well as "birth weight" are important.

According to WHO recommendations live birth the complete expulsion or extraction of the product of conception from the mother's body, regardless of the duration of pregnancy, is considered, and the fetus after such a separation is breathing or showing other signs of life, such as heartbeat, pulsation of the umbilical cord or voluntary movements of the muscles, regardless of whether the umbilical cord is cut and the placenta is separated. Every product of such a birth is considered to be a live birth.

By stillbirth is the death of the product of conception before its complete expulsion or extraction from the mother's body, regardless of the duration of pregnancy. Death is indicated by the absence of breath or any other signs of life, such as palpitations, pulsation of the umbilical cord, or voluntary movements of the muscles, in the fetus after such a separation.

Birth weight the result of the first weighing of a fetus or newborn recorded after birth is considered. This mass must be established within the first hour of life before significant weight loss occurs in the postnatal period. Measurement of the length of the newborn (fetus) must be carried out with its extended position on a horizontal stadiometer.

In the Russian Federation, the following are subject to registration with the registry office:

Those born alive with a body weight of 1000 g or more (or, if the birth weight is unknown, with a body length of 35 cm or more, or a gestation period of 28 weeks or more), including newborns weighing 100 g with multiple births;

All newborns born with a body weight of 500 to 999 g (inclusive), if they have lived more than 168 hours after birth.

However, these parameters do not meet the WHO criteria, and the indicators calculated on their basis are not comparable with international statistics. Therefore, the Federal State Statistics Service of Russia plans to switch to international criteria for registering newborns, in which all born

with a body weight of 500 g or more (if the birth weight is unknown, with a body length of 25 cm or more, or a gestation period of 22 weeks or more) will be registered as live births.

It is important for practical health care to determine the degree of full-term birth of a child. Premature babies are considered to be born when the gestational age is less than 37 weeks and have signs of prematurity. Full-term children are considered to be born at a gestational age of 37-40 weeks. Postterm children are considered to be born at 41-43 weeks of gestation and have signs of overmaturity.

In addition, the concept of prolonged, or physiologically prolonged pregnancy, which lasts more than 42 weeks and ends with the birth of a full-term, functionally mature child without signs of overmaturity, is highlighted.

In connection with the peculiarities of obstetric tactics and nursing of children born at different periods of gestation, it is advisable to distinguish the following intervals:

Premature birth at 22-27 weeks (fetal weight from 500 to 1000 g);

Premature birth at 28-33 weeks (fetal weight from 1000 to 1900 g);

Premature birth at 34-37 weeks (fetal weight from 1900 to 2500 g).

Mortality

To assess the medical and demographic situation of a particular territory, it is necessary to take into account not only fertility rates, but also mortality rates.

Under mortality understand the process of extinction of a population, characterized by the statistically recorded number of deaths in a particular population over a certain period of time.

In accordance with the legislation of the Russian Federation, all deaths are subject to registration with the registry office at the place of residence of the deceased or at the place of death. To register deaths by a doctor or paramedic, a “Medical Death Certificate” (form 106 / u-08) is filled in, without which the delivery of a corpse is prohibited. A “medical certificate of death” is issued no later than 3 days from the moment of death or the discovery of a corpse, if there is no suspicion of a violent cause of death.

The first approximate estimate of mortality is given on the basis of the general mortality rate, which is calculated by the formula:

To estimate the overall mortality rate, use the scheme shown in table. 2.2.

Table 2.2. Scheme for estimating the crude death rate

At the same time, the overall mortality rate does not give a real picture reflecting the state of health of the population, since its value largely depends on a number of demographic characteristics and, in particular, on the characteristics of the age-sex structure of the population. Thus, in a number of economically developed countries, due to an increase in the proportion of elderly people, the overall mortality rate also increases, and, conversely, in developing countries, due to the large proportion of the young population, a decrease in the overall death rate can be observed.

Mortality rates calculated for individual age groups of the population are much more accurate, for which the entire population is divided into separate age intervals for which their indicator is calculated. The numerator is the number of people who died at a given age, and the denominator is the population of a given age. For example, the mortality rate of the working-age population (men 16-59 years old, women 16-54 years old) is calculated using the formula:

Mortality rates for other age-sex groups of the population are calculated in a similar way.

Analysis of mortality rates from individual causes. When calculating mortality from a given cause, the number of deaths from a given cause is taken as a phenomenon, and the average annual population is taken as the environment. For example, mortality from myocardial infarction is calculated using the formula:

In addition to mortality rates from individual causes, mortality rates from individual causes are used in the analysis of the health of the population of administrative territories, which should be distinguished from the former. So, if, when calculating mortality rates, the average annual population is taken as the environment, then when calculating mortality, such an environment is the sick. When calculating mortality, it is customary to take 100 as the basis for the indicator. For example, in contrast to mortality in myocardial infarction, the mortality rate from myocardial infarction is calculated by the formula:

In addition, there is a whole group of special indicators for the analysis of mortality in hospitals - indicators of mortality in a hospital. These include:

Hospital mortality rate;

Postoperative mortality rate;

Daily mortality rate;

One-year mortality rate.

The methodology for calculating and analyzing mortality rates in the hospital is presented in the corresponding chapters of the textbook. Mortality rates allow a comprehensive assessment of the level of organization

medical and diagnostic care, the use of modern medical technologies, continuity in the work of outpatient clinics and hospital institutions are the most important indicators of the quality of medical care.

For an in-depth analysis of the mortality of the population, the indicator of the structure of mortality by causes. This indicator is extensive and is calculated by making a proportion, where all deaths are taken as 100%, and those who died from a particular disease are taken as X%. Having calculated the proportion of deaths from individual diseases, the structure of the causes of death is obtained:

All deaths during the year - 100%;

Died from class I diseases - X%

Deaths from class II - X n%;

Died from n class of diseases - X?%.

The structure of mortality of the population of the Russian Federation by causes is shown in Fig. 2.1.

In the first place is the mortality of the population due to diseases of the circulatory system (56.5%), in second - due to malignant neoplasms (14.6%), in third - due to external causes (11.2%). These diseases account for over 80% of all causes of mortality in the population of the Russian Federation.

The indicators of the structure of mortality by sex and age are also calculated.

Fig. 2.1. The structure of mortality of the population of the Russian Federation by causes (2009)

Maternal, child and perinatal mortality

Along with the general mortality rate, the registration and analysis of maternal mortality is of great importance. Due to its low level, it does not have a noticeable effect on the demographic situation as a whole, but it is one of the main characteristics in assessing the quality of the obstetric service.

Maternal mortality- an indicator characterizing the number of women who died during pregnancy, regardless of the duration and location, or within 42 days after its end from any reason associated with pregnancy, burdened by her or her management, but not from an accident or a sudden cause , correlated with the number of live births.

Maternal deaths are divided into two groups:

1) deaths directly related to obstetric causes (death as a result of a complicated course of pregnancy, childbirth and the postpartum period, as well as diagnostic interventions and improper treatment);

2) cases of death indirectly related to obstetric causes (death as a result of a disease that existed earlier or developed during pregnancy, not related to the direct obstetric cause, but aggravated by the physiological effects of pregnancy).

Maternal mortality rate calculated by the formula:

This indicator in 2009 in the Russian Federation was 22.0 per 100 thousand children born alive.

This indicator makes it possible to assess all the losses of pregnant women (from abortion, ectopic pregnancy, obstetric extragenital pathology during the entire gestational period), as well as women in labor and parturient women within 42 days after the end of pregnancy.

Infant mortality is the most important group of indicators that largely determine the demographic situation in the country.

Infant mortality rates characterize not only the state of health, but also the level of socio-economic well-being, the degree of civilization of society as a whole. A correct and timely analysis of child mortality allows us to develop a number of specific measures to reduce the morbidity and mortality of children, to assess the effectiveness of measures taken, to characterize the work on the protection of mothers and children in general.

Child mortality has a complex structure, including a number of special indicators that have their own calculation characteristics. Each of these indicators characterizes mortality at a certain period in the life of children.

A number of indicators are distinguished in the statistics of child mortality:

1) indicators (coefficients) of infant mortality:

Infant mortality (mortality in the 1st year of life);

Early neonatal mortality (mortality of children in the first 7 days, i.e. 168 h of life);

Late neonatal mortality (mortality of children aged 8-28 days of life);

Neonatal mortality (mortality of children in the first 28 days of life);

Postneonatal mortality (mortality of children aged from the 29th day of life to 1 year);

2) the mortality rate of children under 5 years of age;

3) the infant mortality rate between the ages of 0 and 17, inclusive.

For calculation infant mortality rate there are a number of different ways. The simplest of them is the calculation by the formula:

This indicator in 2009 in the Russian Federation was 8.1%.

At the same time, among children who died during the year before the age of 1 year, there are those who were born both in the last calendar year and in the current one, and the deaths should be correlated only with those born in this

year is incorrect. The use of this method is possible only in the case when the number of births in the reporting and last year is the same, which practically does not occur in real life.

For the calculation of the infant mortality rate, WHO has recommended the Rat's formula, which uses the assumption that among children who died before the age of 1 year in a given calendar year, approximately 1/3 were born in the previous year:

The application of this formula is correct if, among the dead children, the ratio of those born in this and the previous year remains unchanged, but this proportion in practice can change (for example, 1/5 and 4/5, 1/4 and 3/4, etc.). etc.). In such cases, the proportional division method is more acceptable. It consists of two stages.

First stage: the number of children who died during the year in the 1st year of life is taken as 100%, of which:

Those born in a given calendar year are taken for x%;

Those born in the previous calendar year are taken as x 2%. Second phase: the denominator is not a specific, predetermined coefficient (1/5, 1/3, etc.), but the percentage of the number of births, which was determined at the first stage. In this case, the formula for infant mortality will look like this:

Early neonatal mortality rate calculated by the formula:

Late neonatal mortality rate calculated by the formula:

Neonatal mortality rate calculated by the formula:

Postneonatal mortality rate calculated by the formula:

In pediatric practice, the coefficients of late neonatal and postneonatal mortality are calculated using the formulas:

In addition to the infant mortality rate in international practice, it is customary to calculate mortality rate of children under 5 years of age. This indicator has been selected by the United Nations Children's Fund (UNICEF) as an indicator of the well-being of the child population in various states. It is calculated by the formula:

This indicator in 2009 in the Russian Federation amounted to 10.1% o.

To assess the health status of the child population, it is important infant mortality rate, which is calculated by the formula:

This indicator in 2009 in the Russian Federation was 0.98%.

Perinatal mortality. Since 1963, the term "Perinatal period". The World Health Assembly defined the perinatal period as the period that begins with the 22nd full week (154th day) of fetal life (at this time, its normal body weight is 500 g) and ends after 7 full days (168 hours) of life after birth.

The perinatal period includes 3 periods: antenatal (from the 22nd week of pregnancy to labor), intrapartum (labor) and postnatal (the first 168 hours of life). The postnatal period corresponds to the early neonatal period. Each period has its own mortality rate. It should be emphasized that perinatal mortality is not an integral part of infant mortality; the latter includes only one component of perinatal mortality - postnatal (early neonatal) mortality.

Perinatal mortality rate calculated by the formula:

This indicator in 2009 in the Russian Federation was 7.8% 0.

Postnatal mortality is calculated using the same formula as early neonatal mortality. Antenatal and intrapartum mortality add up to stillbirth, which is calculated by the formula:

This indicator in 2009 in the Russian Federation amounted to 4.7% 0.

To register the death of a child (fetus) in the perinatal period, the "Medical certificate of perinatal death" (f. 106-2 / u-08) is filled in. There are two groups of causes of perinatal mortality:

The reasons for the death of the child (fetus) were caused by diseases or conditions of the mother or placenta, pathology of pregnancy, childbirth;

Causes associated with the disease and / or condition of the child (fetus).

Separate study of mortality in the perinatal period and in the 1st year of life does not allow obtaining a complete picture of the loss of all viable children. In this regard, WHO introduced the concept "Fetal infantile loss" (FIP) ... The FIP indicator includes stillbirth and infant mortality in the 1st year of life.

The FIP coefficient is calculated by the formula:

This indicator in 2009 in the Russian Federation was 12.8% 0.

PERINATAL MORTALITY(Greek, peri around, about + lat. natus birth) - mortality of fetuses and newborns in the perinatal period. The perinatal period (see) begins from the 28th week. pregnancy, when the weight of the fetus reaches 1000 g or more and the height is 35 cm or more, includes the period of childbirth and ends by the end of the 7th day of the newborn's life.

P.'s indicator with. includes an indicator of stillbirth - fetal death occurred in the period from the 28th week. pregnancy before the onset of childbirth (antenatal stillbirth) or during childbirth (intrapartum stillbirth) - and an indicator of early neonatal mortality - death occurred in the first 7 days. life (see. Infant mortality, Stillbirth). Early neonatal mortality is 40-60% of the infant mortality rate.

P.'s indicator with. expressed in ppm and calculated by the formula:

[Number of stillbirths + number of deaths in the first 7 days. life] \ [the number of all born (alive and dead)] * ​​1000

P.'s indicator with. in some countries of the world it ranges from 15 to 30 ppm, and in some countries it reaches 45 ppm. In the USSR, according to sample data, P.'s indicator with. in some regions of the country is 12-25 ppm. P.'s indicator with. depends on the socio-economic conditions of the population, the level of medical care, the approach to determining the viability of the fetus and live birth. In the USSR, a fetus is considered viable from 28 weeks. intrauterine development, the weight of which is not less than 1000 g, and the height is not less than 35 cm, a sign of live birth is spontaneous breathing. In order to standardize perinatal statistics, WHO proposes the viability criterion to consider the weight of the fetus or newborn 1000 g (regardless of the gestational age), and if the birth weight is unknown, then the gestational age is 28 weeks. or the growth of the fetus is 35 cm.

P.'s reasons with. divided into immediate (causes that depend only on the fetus) and main (causes that depend on the mother-placenta-fetus system). To the immediate reasons P. of page. include fetal and newborn asphyxia, birth trauma, congenital malformations, hemolytic disease of the newborn. The main role among the direct causes of P. with. belongs to asphyxiation. There is a tendency to an increase in the role in P. with. congenital malformations. In most cases, the immediate causes of P. by page. caused by diseases or patol, maternal conditions, complications of pregnancy and childbirth, pathology of the placenta and umbilical cord. The most frequent main reasons for P. of page. are complicated childbirth, late toxicosis of pregnant women, extragenital diseases of the mother. Almost half of those killed in the perinatal period are premature babies (see).

At the P.'s level. influenced by a number of factors, including the age of the mother, previous abortions, the interval between childbirth, smoking and alcohol consumption during pregnancy, etc. When smoking during pregnancy, toxicosis, premature births occur more often, children are born with low birth weight. Drinking alcohol during pregnancy often leads to late miscarriages, slowing down of the child's psychophysical development, and a lack of weight.

According to sample data, for the first birth, the most favorable age for women is 20-24 years, for the second - 25-29 years. In primiparous women aged 30 years and older, the frequency of preterm birth increases by 1.5 times, 3 times more often surgical delivery interventions are used. In the perinatal period, children die 1.5 times more often in women whose first pregnancy ended in abortion. The optimal for a normal outcome of labor is the interval between births of 2-5 years. Closely correlates with P.'s level of page. baby's weight at birth. The optimal weight is 3000-3500 g.

When developing measures for the prevention of P. s. special attention is paid to the preservation and strengthening of the woman's health before and during pregnancy (see Antenatal fetal protection, Protection of mothers and children). Particular attention should be paid to pregnant women with a high degree of risk in relation to the development of perinatal pathology, measures to combat late toxicosis of pregnant women, abnormal fetal positions, pathology of the placenta and umbilical cord, abnormalities of labor, intrauterine infection of the fetus. Great importance in P.'s prevention by the village. has the use of modern methods of identifying and correcting violations of the health of newborns in the first hours and days of life, methods of resuscitation, as well as strict observance of a dignity. - gigabyte. regime in the departments of newborns.

To identify ways of reducing P. with. it is important to study all cases of death of children in the perinatal period for their systematization and development of rational preventive measures.

Bibliography: Grishchenko VI and Yakovtsov AF Antenatal death of a fetus, M., 197 8, bibliogr .; D and Dina N.M., Grndch and to L.P. and S um and about in and L.M. Obstetric causes of perinatal mortality, in the book: Actual, questions, perinatology, ed. G.M.Savelyeva and V.V. Chernoy, vol. 2, p. 8, M., 1978; To about-sh e l of e in and NG Prevention of perinatal morbidity and mortality, M., 1979, bibliogr .; M at h and e in GS and F r about l about in and OG Health protection of a fetus and a newborn in the USSR, M., 1979; P e t r about in - M and with l and to about in MA and To l and-m e of c II. Perinatal mortality, L., 1965; Guide to the International Statistical Classification of Diseases, Injuries and Causes of Death, vol. 1, p. 419, Geneva, WHO, 1980; Frolova OG, B and and about in and TP and Yankov and MF About ways to reduce perinatal mortality, Akush, and gynecology., No. 11, p. 35, 1976; Chernetskaya EO About the influence of some social and hygienic factors on the level of perinatal mortality, Zdravoohr. Grew up. Federation, no. 8, p. 23, 1975; Thompson J. Perinatal mortality in retrospect and prospect, Scot. med. J., v. 14, p. 89, 1969; Wallace H. M. Factors associated with perinatal mortality and morbidity, Clin. Obstet. Gynec., V. 13, p. 13, 1970.

O. G. Frolova.

PERINATAL MORTALITY (Greek peri - about, around and Latin nata-lis - related to birth), mortality of fetuses and children in the perinatal period (from the 28th week of pregnancy to the end of the seventh day of a newborn's life). P.'s indicator with. includes rates of stillbirth and early neonatal mortality.

P.'s indicator with. expressed in ppm (o / oo) and calculated by the formula:

(number of stillbirths + number of deaths in the first 7 days of life) / number of all births (alive and dead)

P.'s indicator with. in dep. countries fluctuates on average from 15 to 30 o / oo, reaching in some 45-60 o / oo. In the USSR (according to sample data) P.'s indicator with. makes up in dep. districts of the country 12-25 o / oo. P.'s indicator with. depends on the socio-economic. living conditions of us., the level of honey. help, as well as from decomp. approach to determining the viability of the fetus and live birth. In the USSR, the fetus is considered viable from 28 weeks. intrauterine development, the weight of which is not less than 1000 g, and the height is not less than 35 cm; a sign of live birth is considered to be independent. breath.

Main the causes of P. s.- asphyxia (up to 60%), birth trauma (10-12%), congenital malformations (7-8%), pneumonia (5-6%), hemolytic. disease of newborns (up to 3%). Almost half of the deaths in the perinatal period are premature babies (see. Premature baby). At the P.'s level. the use of alcohol and smoking during pregnancy, as well as the age of the mother, previous abortions, the interval between births, etc.

When studying P. with. it is customary to subdivide it into antenatal mortality (fetal death after 28 weeks of pregnancy and before the onset of labor), intrapartum mortality (fetal death during childbirth) and postnatal mortality (fetal death in the first 7 days after birth), edges coincides with the concept of early neonatal mortality. According to the WHO, the rate of antenatal mortality in the world on average is 5-7 o / oo, intrapartum - 7.5-8.6 o / oo, postnatal -2.5-3.2 o / oo.

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  Veterinary encyclopedic dictionary

• - the process of extinction of a generation, one of the two main sub-processes of population reproduction ...

  Demographic Encyclopedic Dictionary

• - an indicator of the rate of extinction of a generation of people. The main characteristic in demography and paleodemography ...

  Physical Anthropology. Illustrated Explanatory Dictionary

• - a massive process, consisting of a multitude of single deaths occurring at different ages and determining in its totality the order of extinction of a real or hypothetical generation of B & nbsp ...

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• - mortality - A quantitative indicator of the intensity of death of individuals in a population, expressed in the number of individuals killed over a certain period of time in relation to the total size of the population or the conditional number of individuals ...

  Molecular biology and genetics. Dictionary

• - I Mortality is the process of population decline due to death; estimated according to special indicators - mortality rates - see Demographic Indicators. II Mortality population decline due to death ...

  Medical encyclopedia

• - see Paranatal oligophrenia ...

  Comprehensive Medical Dictionary

• - a set of diseases, pathological processes and conditions of the fetus from the 28th week of intrauterine development and the newborn in the immediate postpartum period ...

  Comprehensive Medical Dictionary

• - population decline due to death; estimated by mortality rates ...

  Comprehensive Medical Dictionary

• - C. viable fetuses and newborn children; includes antenatal, intrapartum and postnatal ...

  Comprehensive Medical Dictionary

• - MORTALITY in ecology, the number of dead or perished individuals in relation to their total number in the population in a certain area; the intensity of the process of death of individuals in the population ...

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• - demographic indicator characterizing the state of health of the population: the number of deaths per 1,000 population for 1 ...

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• - "... is a collective concept that unites stillbirths and mortality of viable fetuses, starting from 28 weeks of pregnancy within 7 days of life ..." Source: Order of the Federal State Statistics Service of November 22 ...

  Official terminology

• - From a national point of view, it is very important to have as accurate information as possible about the movement of population in general and, in particular, about the number of deaths occurring in the country during a certain ...

  Encyclopedic Dictionary of Brockhaus and Euphron

• - the process of population decline due to death ...

  Great Soviet Encyclopedia

• - population decline due to death. It is characterized by a mortality rate equal to the number of deaths per 1,000 population in 1 year. The mortality rate worldwide in 1985 - 90 was 9.9% ...

  Modern encyclopedia

"PERINATAL MORTALITY" in books

Perinatal encephalopathy (PEP)

From the book From zero to ABC book the author Anikeeva Larisa Shikovna

Perinatal encephalopathy (PEP) Chronic oxygen deficiency of the fetus, acute oxygen starvation that occurs during childbirth, and birth trauma lead to gross disturbances in the central nervous system. These disorders are manifested by perinatal encephalopathy (PEP),

Perinatal Matrix II Antagonism with the mother (contractions in the closed uterus)

author Grof Stanislav

Perinatal Matrix II Antagonism with the mother (contractions in the closed uterus) The second perinatal matrix refers to the first clinical stage of labor. Intrauterine existence, which under normal conditions is close to the ideal, is coming to an end. The world of the fetus is broken, at first insidious

Perinatal Matrix III Synergism with the mother (pushing through the birth canal)

From the book Areas of the Human Unconscious: Evidence from LSD Research [with pictures of patients!] author Grof Stanislav

Perinatal Matrix III Synergism with the mother (pushing through the birth canal) This matrix is ​​associated with the second clinical stage of labor. The contractions continue, but the cervix is ​​already wide open, and gradually the difficult and difficult process of pushing the fetus begins

Perinatal psychology

From the book 365 tips for pregnant and lactating the author Pigulevskaya Irina Stanislavovna

Perinatal psychology When consciously carrying a child, the mother sends him positive emotions, images and thoughts. The child perceives this as a flow of love, and in the memory blocks at the level of sensory intuitive experience, the child acquires a positive lesson, trust in

1. Perinatal CNS pathology

From the book Childhood Diseases: Lecture Notes author Gavrilova NV

1. Perinatal CNS pathology. Etiology. Damage to the central nervous system occurs as a result of a lack of oxygen in the blood of the fetus or newborn, which can be caused by a number of reasons: fetal asphyxiation caused by diseases and intoxication of the mother or caused by

3.36. Perinatal encephalopathy

From the book Child's Health and Common Sense of His Relatives the author Komarovsky Evgeny Olegovich

3.36. Perinatal encephalopathy Diagnostics has achieved such success that there are practically no healthy people left. Bertrand Russell The complex phrase "perinatal encephalopathy" is found in the lexicon of pediatric doctors, and therefore, parents are surprisingly

Perinatal pathology

From the book Hypotension [Newest recommendations. Treatment methods. Expert Advice] the author Krasichkova Anastasia Gennadievna

Perinatal pathology Arterial hypotension during pregnancy worsens the condition of the expectant mother and negatively affects the development of the fetus. Due to insufficient oxygen supply caused by hypotension, the fetus experiences intrauterine hypoxia due to

49. Transpersonal perinatal psychology: I. Charkovsky and school

From the book Transpersonal Project: Psychology, Anthropology, Spiritual Traditions Volume II. Russian transpersonal project the author Kozlov Vladimir Vasilievich

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Chapter 6. Perinatal Ethics

From the book Perinatal Psychology the author Pavel Sidorov

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From the book Mistress of Prison, or Tears of Minerva the author Shvetsov Mikhail Valentinovich

Perinatal psychology knows Stanislav Grof, widely known in scientific circles, wrote: “We seem to be involved in a dramatic race of time, which has no precedent in the entire history of mankind. The future life on this planet is in jeopardy. If we continue

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From the book Antistress for Parents-to-be the author Tsarenko Natalia

Perinatal psychology Surely you have heard a lot about the fact that the baby "remembers" everything that happened to him almost from the moment of conception, and all events that occur during pregnancy, during and after childbirth are imprinted in his psyche. This idea is one of

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author Grof Stanislav

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From the book Traveling in Search of Yourself author Grof Stanislav

Third Basic Perinatal Matrix (BPM III), the struggle between death and rebirth

From the book Traveling in Search of Yourself author Grof Stanislav

The Third Basic Perinatal Matrix (BPM III), the fight between death and rebirth

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From the book Traveling in Search of Yourself author Grof Stanislav