Tragedy during childbirth: what are the causes of maternal mortality? Why women still die in childbirth

Which Orthodox Christian is not familiar with the words from the litany of petition about “the Christian end of our life, painless, shameless, peaceful...”? They indicate that a person’s dying can occur in different ways: in agony and terrible torment or peacefully, painlessly, and shamelessly. You can die young, unexpectedly and suddenly, having been in a random accident, or you can die seriously and for a long time, await your death, having confessed and received communion. You can die saving the life of another person, or you can die from heart failure while intoxicated. There are different types of death...

Which of them refers to the death of a mother during childbirth? What to do when it is known in advance that the resulting pregnancy threatens the life of the mother herself?

Today in our society it is not yet possible to find a clear answer to this question. This ambiguity has its own reasons, its own history and logic. There are two opposing positions in this logic. The movement from one of them to the other contains the history of the formation of the correct answer to the question that concerns us.

The first position was expressed back in the 5th century BC. in the Hippocratic Oath. Among numerous medical manipulations, Hippocrates specifically singles out fetal expulsion and promises: “I will not give any woman an abortifacient pessary.” This doctor’s judgment is all the more important because it runs counter to the opinion of many great moralists and legislators of Ancient Greece, for example Aristotle, about the fundamental admissibility and practical expediency of abortion. Hippocrates clearly and unambiguously expresses the position of the medical class on the ethical inadmissibility of a doctor’s participation in the production of an artificial miscarriage.

The opposite position is most clearly expressed in the principle of the Jewish physician and theologian Maimonides: “The attacker should not be spared.” He almost literally transfers the well-known maxim of Old Testament morality to the relationship between mother and child - "an eye for an eye a tooth for a tooth"(Lev. 24:20). Already from the 13th century, this rule began to be interpreted as a permission to kill a child in the mother’s womb, which was carried out by a doctor to save the life of the mother. Today, such manipulation is defined by the term “therapeutic abortion.” Therapeutic abortion is the destruction of a child in the event of a conflict between the life of the mother and the fetus; it is an abortion during which the child is destroyed in order to save the life of the mother.

Recognition of therapeutic abortion is a break not only with the moral position of Hippocrates, but also a challenge to the Christian moral tradition, for which, as is known, " immortal life a child is more valuable than the temporary life of the mother."

Since the beginning of the twentieth century in Russia, the indisputable Christian ethical traditions of the medical community have begun to come under criticism. On the pages of Russian medical journals and newspapers there is a very intense discussion of the ethical and medical problems of induced abortion. Thus, in 1911, Dr. T. Shabad was practically one of the first to raise the question of “the mother’s right to control the function of her body,” especially in the event of a threat to her life. In fact, Shabad is at the origins of the liberal approach to induced abortion, trying to find arguments against the prevailing moral tradition in the "testaments" of Dr. Maimonides.

After 1917 in Russia, discussions about therapeutic abortion completely ceased, due to the complete legalization of abortion, based on the official ideology’s declaration of “the mother’s right to control the function of her body” and the absolute availability of abortion operations. artificial interruption pregnancy not only medical indications, but also simply at the request of the woman. An act such as abortion has not been a crime since 1917. On the contrary, abortion was considered a socially significant achievement, because, as Lenin assured everyone, “there is not a grain of ethics in Marxism.”

What to do today, when such Leninist “truth”, which turned Russia into a country of mass infanticide, still dominates the minds of medical specialists? How to free yourself from the grip of the arbitrariness of a fallen man who has come to believe in the legitimacy of the violence of his will and passions?

It is impossible to agree with the recognition and justification of therapeutic abortions. It contradicts conscience as the internal ability to experience and recognize evil. It contradicts mind as the ability to understand and explain the inadmissibility of therapeutic abortion. The grounds for such inadmissibility for an Orthodox person include the following:

A) Therapeutic abortion is a form conscious killing a child, which conflicts with the 2nd and 8th Rule of the Orthodox Faith of St. Basil the Great, according to which "Whoever intentionally destroyed a fetus conceived in the womb is subject to conviction as for murder". At the same time, Bishop Nicodemus specifically emphasizes the difference between the Orthodox and Old Testament attitudes towards human life, the beginning of which in the Old Testament tradition is associated only with the emergence of human-like features in the fetus, while Orthodox anthropology does not make such distinctions. It connects the beginning of human life with the very moment of conception, as evidenced by the Annunciation of the Archangel Gabriel and the glorified Orthodox Church conception of the holy righteous Anna Holy Mother of God and the conception of John the Baptist.

b) Saint John Chrysostom claims that exile is “something worse than murder,” for it represents a violation of the “first and greatest commandment” - the commandment of love. The conscious killing of her child by a mother in order to save her life is an action that not only violates the commandment of love, but is also the opposite of fundamental Christian ideas:

• firstly, about the deep moral essence of motherhood,
• secondly, about a shameless and worthy Christian death,
• thirdly, about the role of sacrificial love in human relationships.

V) Christian veneration of the military and the socially significant status of a soldier are determined by his conscious readiness to lay down his life for children, women, and the elderly: “Greater love has no one than this, that a man lay down his life for his friends.”(John 13:15). Justifying the conscious refusal of a sacrificial attitude towards her child on the part of the mother is an action that is flagrant in its anti-Christian essence. Archpriest Dimitry Smirnov in the book “Save and Preserve” writes: “After all, extending one’s life at the cost of killing one’s own child is tantamount to a mother eating her baby - such cases happened in besieged Leningrad. When a mother wants to save her life at the expense of her child, this is cannibalism.” .

G) Today, as a result of the development of medical science, which has successfully overcome previously difficult-to-treat diseases, cases in which there really is a need to terminate a pregnancy for medical reasons occur. rarely. But the failure to recognize the moral unacceptability of therapeutic abortion gives rise to the widespread practice eugenic abortion, produced in order to prevent the birth of defective or sick children. Today, due to the powerful development prenatal diagnosis the production of eugenic abortions is gaining momentum.

In conclusion, one cannot help but recall the ancient principle, which directly relates to therapeutic abortion: “Non sunt facienda mala ut veniant bona” (you cannot create evil from which good would come). Without accepting a natural “shameless, peaceful” death in childbirth, modern medicine produces, produces the most terrible kind death - eternal spiritual death.

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

Causes of death during childbirth

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

In the International Classification of Diseases and Related Health Problems, 10th revision (1995), the definition of “maternal mortality” has remained virtually unchanged compared to ICD-10.

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

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

Deaths during childbirth are divided into two groups:

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

Along with stated reasons(main) it is advisable to analyze random causes of death (accidents, suicides) of pregnant women, women in labor and postpartum within 42 days after completion of pregnancy.

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

Death statistics during childbirth

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

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

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

About 50 years ago, countries in the European Region first formalized health care systems for pregnant women based on routine screening and visits to a doctor or midwife at regular intervals. With the advent of more sophisticated laboratory and electronic technology, a large number of tests and the number of visits has been changed. Today, every country in the European Region has a legally established or recommended system of visits for pregnant women: for uncomplicated pregnancies, the number of visits varies from 4 to 30, with an average of 12.

Statistics of death during childbirth in Russia

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

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

Of the deaths, more than 7% die at the age of 15-19 years (2.4% at the age of 15-17 years and 5% at the age of 18-19 years), which amounts to 11 and 23 maternal deaths, respectively.

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

In 2003, according to the State Statistics Committee of Russia, no deaths during childbirth were registered in 12 territories: the Komi Republic, the Altai Republic, the Karachay-Cherkess Republic, the Kaliningrad and Kamchatka regions and in 7 autonomous regions with a small number of peoples: Chukotka, Koryak, Komi- Permyatsky, Taimyrsky (Dolgano-Nenetsky), Evenkisky, Ust-Ordynsky, Buryatsky, Aginsky Buryatsky; in 13 territories the maternal mortality rate is below 15.0; in 4 territories the maternal mortality rate exceeds 100.0 (Nenets Autonomous Okrug, Republic of Mari-El, Jewish Autonomous Region and Republic of Tyva).

Data for the constituent entities of the Russian Federation are presented in table. 1.12.

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

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

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

There are also differences in the structure and causes of maternal mortality. Thus, in 2003, the rate of death during childbirth among women living in rural areas was 2.1 times higher than the same rate among women living in urban areas after an abortion that was initiated or started outside a medical institution, by 2.1 times from postpartum sepsis, and by toxicosis. pregnancy - 1.4 times, from bleeding during pregnancy, childbirth and the postpartum period (total) - 1.3 times. In total, in 2003, every fourth of the deaths classified as maternal mortality died from septic post-abortion and postpartum complications.

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 an anesthesiologist-resuscitator and an obstetrician-gynecologist.

The main complications caused by the action of anesthesiologists were:

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

The main complications caused by the activities of obstetricians and gynecologists include:

• traumatic organ injuries abdominal cavity;
• ligature divergence;
• delay in surgical intervention, including hysterectomy;
• failure to provide necessary medical care.

In order to reduce deaths during childbirth among women living in rural areas, the following measures are necessary.

1. Conduct a more thorough selection among rural women at risk of maternal mortality (establish monitoring) and refer them to prenatal hospitalization in institutions high degree risk.
2. Considering the high proportion of mortality from postpartum sepsis, implement a more balanced individual approach to the early discharge of postpartum women living in rural areas, taking into account the medical and social risks of purulent-septic postpartum complications, as well as establish mandatory patronage of postpartum women by the medical staff of FAPs and OPs (in accordance with with order No. 345 of November 26, 1997) and train primary health care medical personnel in the diagnosis of purulent-septic postpartum complications, including early clinical manifestations their.
3. Considering the large proportion of deaths after abortions initiated and/or started outside a medical institution, take measures to increase the availability of artificial abortions, including short-term abortions, using state guarantees for the provision of free medical care, and also address Special attention to prevent unplanned pregnancy among residents of rural areas and arrange for them, as the most socially unprotected and low-income segments of the population, to be provided free of charge effective means contraception.
4. Provide free travel on transport of pregnant women and women in the postpartum period from rural areas to the level of the central district hospital and from the central district hospital to the level of regional (territorial, republican) institutions for dispensary observation and if necessary, consultation and treatment in a high-risk health care facility.
5. Provide rural women with high-tech and specialized gynecological care (endoscopic operations, organ-preserving operations, etc.).

Prevention of death during childbirth

IN last years The obstetric service strategy was built on two principles: identifying pregnant women at high risk of perinatal pathology and ensuring continuity in the provision of obstetric care. Much attention, which was focused on perinatal risk in the 70s, began to weaken in the 90s.

Other important characteristic systems of care during pregnancy - continuity of care. In Europe, the vast majority of systems treat pregnancy, childbirth and the puerperium as three separate clinical situations requiring a variety of clinical expertise, different medical personnel and different clinical settings. Therefore, in almost all countries there is no continuity of care provided during pregnancy and childbirth, i.e., a pregnant woman is cared for by one specialist, and the birth is carried out by another who has not previously observed her. Moreover, changing personnel every 8 hours of work also does not ensure continuity of care during childbirth.

The Netherlands, a developed European country with a highly organized system of home birth services (36%), has the lowest rate of death during childbirth and newborns. Monitoring of low-risk pregnant women and birth at home is carried out by a midwife and her assistant, who assists during childbirth and stays in the house for 10 days to help the birthing mother.

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

In Denmark, the law allows home births, but some counties have won permission to waive the rule due to a shortage of midwives. Giving birth without the assistance of a professionally trained person is illegal in the UK and Sweden. In North America, giving birth at home without appropriate assistance is not illegal.

In the United States in 1995, deaths during childbirth were 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%), gestosis in pregnant women (1.2 or 16.9%), bleeding (0.9 or 12.7%), ectopic pregnancy(0.5 or 7%).

The largest volume of prenatal care occurs in the first trimester of pregnancy

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

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

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

They met the doctor of the Perinatal Center, Svetlana Raikova, in March 2008, and decided that she would monitor Yulia and provide assistance during childbirth. Twice in April and May, Yulia was kept in the Perinatal Center. By the end of May, the woman began to experience swelling.

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

At 6 am on June 1, I called the maternity hospital, asked about my wife, and they told me: “You better come,” recalls Peter. “My mother-in-law and I left immediately.” None of the doctors met us, and the guard at the gate said: “Are you relatives of the woman who was taken to the morgue?” Then some unknown doctor came out and said that his wife’s heart couldn’t stand it.

But Svetlana Raikova never spoke to her relatives.
- Everyone explained to us what happened, everyone offered condolences and apologies, except her! - Pyotr Mozhaitsev is indignant. “They told me that she was scared, confused, that when she realized that it was too late to change something, she called all the doctors, and they rushed to the maternity hospital at night in whatever way they could. I don't blame the doctors who performed the second operation and tried to revive her. There is so much talk everywhere about the Perinatal Center, but not a word about our tragedy!

Vika’s 9-year-old daughter is now support and consolation for her father. She somehow immediately matured, but before she was so carefree. Petra’s sister, 36-year-old Natalya, is caring for the babies and has taken out maternity leave for children up to one and a half years old. Other relatives also help. So it is impossible to say that Peter was left alone with his misfortune. But he himself does not know how to live further.

At the funeral they told me, “Don’t give away Yulina’s things until forty days,” he says. “They don’t understand, for me it’s like a museum: you open the closet, there are her dresses, perfume, her smell, and it seems as if she is nearby.

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

“She followed me like a little child,” he recalls. “When I left, she wrote me letters about love and gave them to me when I returned. She never raised her voice, not once with me or with my parents - not a single conflict, they lived in such love that everyone was jealous.

What about now?

“No one is immune from death in childbirth”

Mortality cases associated with pregnancy and childbirth are very rare, but have a special social significance, this is grief for the family and loved ones, children are often orphans, says Natalya ZERNAEVA, head of the department of medical problems of family, motherhood, childhood and demographic policy. - Death of Yulia Vyacheslavovna Mozhaitseva in the perinatal center of the regional clinical hospital, which is the leading obstetrics institution in the region and where highly qualified health care for women with complicated childbirth and serious illnesses, it is difficult for all medical workers involved in the management of pregnancy and childbirth.

The Department of Health and social protection population of the region, a commission was created to determine the reasons that led to the tragedy. During the internal audit, all stages of medical care were analyzed. The course of Yulia's pregnancy was complicated by gestosis in the second half of pregnancy, for which reason she was hospitalized and received treatment not in the usual pregnancy pathology department, but in the intensive care unit of the perinatal center.

The therapy allowed to stabilize the course of the disease, however, due to the onset of uterine rupture along the scar (a “caesarean section” was performed in the first birth), amniotic fluid entered the vascular bed. Embolism amniotic fluid, confirmed by histological examination, is an unpreventable cause of death. Brigade the best specialists from 11 p.m. on May 31 to 6 a.m. on June 1, she tried to save Yulia’s life; everything possible was done.

Maternal mortality with this pathology is 85 percent, these are global indicators, says Lydia VASILCENKO, deputy chief physician for obstetrics at the St. Joasaph Regional Hospital. – Over the past 10 years, we have not had a single similar case at the Perinatal Center, and we are all, of course, very worried and sympathize with this family.

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

I don’t want to make excuses, I understand relatives blaming the doctor, but doctors are not omnipotent,” says Lidiya Sergeevna.

Babies are monitored directly by specialists from the perinatal center. Special meals are provided for infants. Disciplinary measures were taken against the staff of the perinatal center.

Members of the commission talked with Yulia’s relatives, all the reasons that led to the tragedy were explained, says Natalya Zernaeva. “However, the family’s grief is incommensurate with any of our explanations.” Once again I want to offer my apologies and deep condolences to the family of Yulia Vyacheslavovna Mozhaitseva on my own behalf, to everyone medical workers. Forgive us!

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

For doctors, this is just a case. How should we live? For all of us, this is a lifelong grief.

Eclampsia has 2 prestages. Late toxicosis, preeclampsia and then eclampsia. In the first stages - swelling, high blood pressure, the presence of protein in the urine. The prestages develop over several days. More likely you had signs, but you didn’t pay attention to them. Signs of future eclampsia can be seen already in blood tests 4-5 weeks before visible signs, but they will try to save both. So that I would not suspect my condition, my husband was invited to be present at the caesarean section. Then they connected me to a bunch of computers and took me away, and the baby was taken to the neonatal unit... My legs didn’t move for 3 days. I was afraid that they were taken away.

After it was all over, the doctor explained my situation to me. Answered all current questions. He said that they are trying not to reach the point of eclampsia, since the fatal outcome is very high. That's why they cut it quickly: You wouldn't live until the morning. Class! I still cringe from this. The second pregnancy was easier.

First, some statistics regarding maternal mortality and how it is compiled. According to the accepted methodology, statistics on maternal mortality include not only death during childbirth, the causes of which can be very diverse - they will be discussed below. The data includes deaths that occurred throughout pregnancy and up to 42 days after birth. Abroad, the statistics include cases of maternal death after an abortion, but in Russia they do not.

The number of deaths of women per 100,000 births is considered the most important indicator that directly characterizes the level of development of medicine and obstetric care in a particular country, and in large states such as Russia - and its regions. According to the Ministry of Health, in 2017 this rate was 7.3 per 100,000 births, which is quite comparable to the rates in the most developed countries on the planet.

In the 33rd region of the Russian Federation, zero maternal mortality was recorded: this means that in 2017 there was not a single tragic case of death during childbirth.

The most common cause of death during childbirth is hemorrhage

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

• Placental abruption can cause fetal and maternal death.
• Uterine rupture, which occurs as a result of several reasons: a large fetus or a too small pelvis of the woman in labor, neoplasms of the uterus or ovaries, transverse position of the fetus.
• Birth bleeding can begin with non-standard separation of the placenta and injuries (ruptures) of the birth canal. Serious blood loss is possible in very short time and, if blood and plasma are not available for transfusion, death may occur as a result of blood loss.
• Bleeding disorders, congenital and acquired.

The risk of death due to postpartum hemorrhage remains for a month after birth. The happy mother and baby have already been discharged home, but bleeding can open in a few weeks and lead to death. It is very important for the mother in labor and her loved ones to monitor blood pressure, vaginal discharge, painful sensations in a stomach. If a woman’s general condition worsens for no apparent reason, she urgently needs to sound the alarm and seek help from doctors.

Obstetric sepsis

Most often occurs in the postpartum period. These are infections of birth wounds and tracts caused by the penetration of penicillin-resistant staphylococcus and various bacteria into them. But is it really difficult to maintain the minimum level of safety during manipulations and interventions during childbirth, and to sterilize instruments? Even if the medical staff fulfills all the requirements, the cause of septic infection can be the natural microflora of the vagina, which under certain conditions turns into pathogenic.

The trouble is that doctors are faced with microbes that quickly adapt to the action of modern antibiotics. Sepsis – severe infection, it is not easy to fight him. How to reduce risks? A pregnant woman should strengthen the strength of her body in every possible way, which is facilitated by balanced diet and taking vitamins. When or in water, you should carefully observe all hygiene requirements, disinfect linen, clothing, and bedding.

Preeclampsia is the cause of almost 20% of deaths during childbirth

About 18% of all pregnancies are last weeks before childbirth are accompanied by the so-called “ late toxicosis" The occurrence of gestosis is associated with disturbances in the hormonal regulation of organs and systems, neuroses and even a genetic factor.

The development of gestosis leads to serious disruptions in the functioning of a woman’s cardiovascular system, the kidneys may fail, and tissue necrosis occurs in the liver. The placenta undergoes changes, which can cause oxygen starvation of the fetus with unpredictable consequences, including intrauterine death.

Severe gestosis leads to eclampsia, when severe convulsive attacks occur. A woman in labor can fall into a coma, seizures provoke hemorrhages, and in the worst case, eclampsia leads to the death of the woman.

Diseases “outside” pregnancy

These are “ordinary” and well-known diseases, but this does not make them any less dangerous and can cause the death of a woman in labor. These are diseases not related to the reproductive function of a woman; they are called extragenital. These causes include diseases of cardio-vascular system(heart defects, hypertension 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 a woman in labor.

According to statistics, extragenital diseases of women in acute form lead to death during childbirth in 15% of fatal cases.

A cunning killer. HELLP syndrome

A very complex pathology that usually occurs in the last weeks of pregnancy (very rarely in the first days after birth) and is closely related to late toxicosis. The causes of HELLP syndrome have not been reliably established; there are several dozen hypotheses, but none is recognized as the main one. They are called autoimmune diseases, genetic predisposition, taking drugs and substances that interfere with the activity of a woman’s liver.

The pathology is complex: red blood cells are destroyed, the amount of liver enzymes increases, the level of platelets decreases, which causes a violation of blood clotting and thickening. The mother's liver tissue is destroyed (hepatosis), pain symptoms are observed in the hypochondrium, severe jaundice skin. A sure symptom of this disease is swelling, vomiting, and fatigue.

If measures are not taken in time, the woman in labor may fall into a coma and die: with this disease, the probability of a favorable outcome is no more than 25-35%, because it is not for nothing that HELLP was nicknamed “an obstetrician’s nightmare.” Death occurs as a result of complications: cerebral hemorrhages, thrombosis, acute liver failure...

Diagnosis of the syndrome is made based on laboratory tests blood, ultrasound, urine analysis, computed tomography. After emergency hospitalization, if the diagnosis is established, immediate stimulation is required labor activity or emergency caesarean section if natural childbirth are impossible in time or the mother’s condition is worsening every hour.

A boy came into a toy store and asked to wrap a car for him. Then he handed the cashier some toy money. The cashier laughed.
- Why are you laughing? - the kid didn’t understand. — The car isn’t real either!

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

If measures are taken in time, the life of the mother and baby is not in danger, but you will have to undergo long-term treatment in a hospital, stabilize the mother’s blood counts, and restore the functioning of the liver and kidneys. Blood and plasma transfusions are indicated, and various medications are prescribed.

Death during childbirth as a result of HELLP occurs in approximately 4% of the total number of deaths of women in childbirth.

Death due to complications after surgery

It's mainly about caesarean section. Like any surgical operation, cesarean carries risks for the woman in labor. Sometimes a caesarean section is resorted to when a woman’s health condition has deteriorated significantly, or natural childbirth is beyond her capabilities.

Important advice from anesthesiologists, on which your life may depend: before a caesarean operation, 8 hours before it begins, it is strictly forbidden to eat or even drink anything. Pay close attention to your doctor's recommendations!

The operation itself is not too complicated, even for an inexperienced surgeon. Blood and plasma are always ready for transfusion, the patient’s condition is monitored using instruments, and in extreme cases, there is an intensive care unit nearby. During the operation, death of a woman in labor occurs extremely rarely; most cases occur in the postpartum period. Internal bleeding and complications are frequent, the slightest negligence or oversight of personnel leads to tragedy, and resuscitators no longer have time to save the woman.

Death of a mother in labor as a result of medical error

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

1. The causes of death of a woman in labor are the responsibility of gynecologists and obstetricians. Lack of experience and skills on the part of an obstetrician can lead to injuries to a woman’s organs. There are belated decisions about the need for surgical intervention, untimely and incomplete medical care provided during childbirth and in the postpartum period.
2. Anesthesiologists and resuscitators are responsible for deaths during childbirth. There are errors during epidural anesthesia, overdose during infusion therapy, injuries and complications during resuscitation measures, and death can occur as a result of anaphylactic shock. According to statistics, about 7% of deaths during childbirth occur for reasons related to anesthesia.

Sometimes the death of a woman is accompanied by circumstances that are not entirely clear, and doctors, while respecting corporate interests, are not always ready to admit mistakes - after all, this entails criminal liability under Article 109 of the Criminal Code of the Russian Federation! Criminal cases involving the death of a woman in a maternity hospital or the death of a child during childbirth usually become public knowledge; these sad topics are actively covered in the press and are difficult to hush up.

The husband or immediate relatives are obliged to file a statement with the police or prosecutor's office and achieve a fair investigation. It’s hard to do this after such grief, but it’s necessary. A special commission will be appointed, an independent examination will be carried out, and the court will determine the perpetrators and impose punishment, or acquit them if guilt in the woman’s death is not proven.

How to reduce the risk of death?

It is impossible to insure yourself 100%, but there are still simple recommendations. First of all, during pregnancy you need to undergo all the required examinations, get tested regularly, see a doctor in antenatal clinic. If a doctor prescribes or recommends something, you need to trust him and follow it conscientiously. Regular examinations will help identify hidden diseases and diagnose deviations from the normal course of pregnancy. You need to carefully monitor your health, eat well, avoid stress: even if these are not the most important factors, but still.

Little Petya asks little Marina:
- When we grow up, will you marry me?
- No.
- Why?
- You see, in our family everyone marries their own. For example, my grandfather married my grandmother. My dad is on my mom, my uncle is on my aunt...

The cause of death during childbirth can be untimely medical care if a woman gives birth at home. The ambulance may be late or stuck in city traffic jams if something goes wrong. Delay in emergency care is the main argument of opponents of home birth, but according to statistics, death during childbirth at home is no more common than in the most modern maternity hospital with highly qualified doctors, midwives, and resuscitators.