Modern aspects of perinatal mortality in Ukraine

Abstract

Perinatal mortality is one of the important indicators of the national public health system, its demographic perspective, which is highly sensitive to socio-economic factors, the reproductive health of the population, and the effectiveness of health care facilities.

Purpose — to conduct a retrospective analysis and assessment of the dynamics of perinatal mortality and its main components, to determine its dependence on the health condition of mothers and newborns.

Materials and methods. The analysis was performed using data from the State Statistics Service of Ukraine and the State Institution «Center for Medical Statistics of the Ministry of Health of Ukraine» for the period 2000–2019, data from the perinatal audit according to WHO «MATRIX — BABIES» methodology. The methods of a systematic approach, structural-logical, epidemiological analysis are used.

Results. The data of the research demonstrated that an unfavorable demographic situation is accompanied by an unsatisfactory health condition of mothers and newborns. During the third millennium, the prevalence of menstrual disorders by 32.7%, inflammatory diseases of the cervix uterus by 82.5%, malignant neoplasms of the uterus by 33.9%, mammary glands by 15.3%, and the incidence of diabetes in pregnant women 9.6 times, diseases of the thyroid gland by 16.1%, diseases of the circulatory system by 31.2%, diseases of the genitourinary system by 12.3% have been increased among women. A negative trend is observed in the objective indicator of the health of newborns — the incidence of light weighted newborns (5.39% in 2000 and 5.78% in 2019), the newborn health index is still low with positive dynamics — 72.8%, and 84.2% respectively. In general, the perinatal mortality rate in Ukraine, recalculated according to WHO criteria, decreased by 3.1 times — from 27.1 per 1,000 live and dead births in 2000 to 8.64 in 2019, but it still exceeds the average figure for the EU countries — 6,1‰ and the European Region — 7.2‰ (2017). According to the State statistics of Ukraine, a decrease in perinatal mortality occurred only due to a decrease in early neonatal mortality (from 4.71‰ in 2000 to 2.99‰ in 2018) with a tendency to increase stillbirth (from 5.4‰ to 5.91‰ respectively).At the same time, an excess of the real indicator of early neonatal mortality over the actual one was found to be 2.2–2.3 times higher, which leads to an underestimation of the general indicator of perinatal and infant mortality.

Conclusions. A decrease in the level of perinatal mortality and its components requires the further development of regionalization of perinatal care, the completion of the establishment of level III perinatal care centers, the revision and maintenance of patient pathways, the development and provision of state-guaranteed medical services/standards (standard for the safety of the child, pregnant woman and the woman in childbirth), to ensure the reliability of the determination body weight at birth, criteria for live birth and stillbirth.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of this Institute. The informed consent of the patient was obtained for conducting the studies.