History and prospects of perinatal mortality rate in Russia

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Population reproduction is a priority task of social policy and a factor of Russia’s national security. The review presents the stages of recording the perinatal mortality indicator, which is closely related to the frequency of preterm birth. In the first stage, the criteria for registering preterm birth were 28 weeks of pregnancy, and in the second, since 2012, — 22 weeks. At both stages, due to underreporting of low birth weight babies (their transfer to the “miscarriage” group), stillbirths, including full-term babies, prevailed in the preterm birth indicator structure. The authors of the article stressed that the main cause of preterm birth (including iatrogenic) is the formation of endotoxemia syndrome, or “systemic effects of aggressive metabolites” in the mother – placenta – fetus system. In this etiopathogenetic therapeutic means are methods of efferent therapy in the form of plasmapheresis, etc. These technologies in many obstetric pathologies (thrombophilia, preeclampsia, Rh-conflict, isthmic-cesmic and chronic placental insufficiency, etc.) sanitize the mother – placenta – fetus system and allow to prolong pregnancy with a reduction of perinatal mortality index. The authors cite their own data on the use of efferent therapy methods in 102 women presenting at 22–28 weeks of pregnancy to the Perinatal Center of Saint Petersburg State Medical University from other institutions after unsuccessful treatment according to the Protocols for various obstetric complications. Pregnancies were prolonged by 2–15 weeks; all 123 children (20 twins, 1 triplet) were born alive, did not require long-term intensive care, survived and were not disabled. Six newborns died and the perinatal mortality rate was 48 : 1000, which is an order of magnitude lower than that quoted in the literature for similar pathologies and gestational ages. In conclusion of the article, it is suggested that in order to reduce perinatal mortality in Russia, all large institutions should arrange efferent therapy rooms to treat sick pregnant women using the safe, low-cost technologies developed by the authors, using domestic equipment.

About the authors

Dmitry O. Ivanov

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: doivanov@yandex.ru

MD, PhD, Dr. Med. Sci., Professor, Chief Freelance Neonatologist of the Ministry of Health of Russia, Rector, Head of the Department of Neonatology with courses of Neurology and Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Vladimir V. Vetrov

St. Petersburg State Pediatric Medical University

Email: vetrovplasma@mail.ru

MD, PhD, Dr. Med. Sci., Associate Professor, Department of Neonatology with courses of Neurology and Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Lyudmila V. Kurdynko

St. Petersburg State Pediatric Medical University

Email: l.kurdynko@yandex.ru

Head of the Obstetrical Physiology Department

Russian Federation, Saint Petersburg

References

  1. Avilov AV, Kosymov EA, Vanin EY, et al. Risk factors for development of disability in children born with extremely low and very low body weight. The Journal of Scientific Articles Health and Education Millennium. 2017;19(12):63–67. (In Russ.)
  2. Adamyan LV, Serov VN, Sukhikh GT, et al., editors. Clinical Recommendations. Obstetrics and Gynecology (Special Issue): textbook. Мoscow, 2016. 470 p. (In Russ.)
  3. Ailamazyan EK, Pavlova NG. Izoimmunizatsiya pri beremennosti. Saint Petersburg; 2012. 164 Р. (In Russ.)
  4. Alekseenko LA, Kolmakov IV, Shinkarenko EN, et al. Vykhazhivanie novorozhdennykh ot sverkhrannikh rodov v perinatal’nom tsentre okruzhnoi klinicheskoi bol’nitsy: rezul’taty i perspektivy. Zdravookhranenie Yugry: opyt i innovatsii. 2017;(3):4–9. (In Russ.)
  5. Baibarina EN, Shuvalova MP, Pismenskaya TV. Tendentsii snizheniya perinatal’nykh poter’ v Rossii. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 472. (In Russ.)
  6. Baranov AA, editor. Zdorov’e detei Rossii Moscow; Soyuz pediatrov Rossii. 1999. Р. 273. (In Russ.)
  7. Baranov AA, Al’bitskii VYu. Smertnost’ detskogo naseleniya Rossii (tendentsii, prichiny i puti snizheniya). Moscow: Soyuz pediatrov Rossii; 2009. 383 p. (In Russ.)
  8. Baranov AA, Shcheplyagina LA, Ilyin AG, et al. Children’s health status as a factor of national security. Russian Pediatric Journal. 2005;(2):4–8. (In Russ.)
  9. Bashmakova NV, Malgina GB, Shabunina-Basok NR, et al. Perekhod na novye kriterii: chto izmenilos’ v strukture prichin perinatal’noi smertnosti? Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 473. (In Russ.)
  10. Bayalieva AJ, Ziganshin IM, Babintseva AA. Analysis of respiratory therapy of newborns with extremely low birth weight. Russian Bulletin of Perinatology and Pediatrics. 2019;64(5):171–175. (In Russ.) doi: 10.21508/1027-4065-2019-64-5-171-175
  11. Bezhenar VF, Ivanova LA, Ailamazyan EK. Perinatal loss dynamics in St. Petersburg and the Leningrad Region in 2006–2018: analysis, conclusions, forecast. Journal of Obstetrics and Women’s Diseases. 2020;69(3):63–71. (In Russ.)
  12. Bugerenko AE, Sukhanova DI, Donchenko YaS, et al. Placental angioarchitectonics in feto-fetal transfusion syndrome in pregnant women with monochorionic twins. Perinatal outcomes. Obstetrics and gynecology. 2019;(5):63–69. (In Russ.)
  13. Vetrov VV, Levanovich VV, Yaroslavskii VK, et al. Sposob lecheniya pozdnego toksikoza beremennykh. Zhurnal Otkrytiya, izobreteniya. 1989;(8):19. (In Russ.)
  14. Vetrov VV, Levanovich VV. Rol’ molekul srednei massy v patogeneze pozdnego toksikoza beremennykh. Obstetrics and gynecology. 1990;66(8):50–54. (In Russ.)
  15. Vetrov VV. Efferentnaya terapiya i autodonorstvo v akusherskom statsionare. Saint Petersburg: SPbMAPO; 2003. 164 Р. (In Russ.)
  16. Vetrov VV, Ivanov DO. Dinamicheskii analiz prichin perinatal’nykh poter’ v nekotorykh regionakh Rossiiskoi Federatsii v 2012–2015 gg. Mediko-Sotsial’nye Problemy Sem’i. 2016;21(1):31–35. (In Russ.)
  17. Vetrov VV, Ivanov DO. Yatrogennye prichiny perinatal’noi i mladencheskoi smertnosti v RF za 2012–2017 gg. In: Rukovodstvo po perinatologii. 2nd edition, revised and supplemented. In 2 vol. Vol. 1. Ivanov DO, ed. Saint Petersburg; 2019. P. 156–164. (In Russ.)
  18. Vetrov VV, Ivanov DO, Reznik VA, et al. Rezul’taty eferentnoi terapii u beremennykh pri angidramnione razlichnoi etiologii (tri klinicheskikh nablyudeniya) Medicine: theory and practice. 2019;4(S):137–138. (In Russ.)
  19. Vetrov VV, Ivanov DO, Reznik VA, et al. Methods of efferent therapy in prolongation of pregnancy in isthmic-cesmic insufficiency (two clinical observations). Pediatrician (St. Petersburg). 2019;10(1):101–104. (In Russ.) doi: 10.17816/PED101101-106
  20. Vetrov VV, Ivanov DO, Reznik VA, et al. Results of efferent therapy in monochorionic diamniotic twin with fetal developmental dissociation (three clinical observations). Pediatrician (St. Petersburg). 2019;10(2): 111–120. (In Russ.) doi: 10.17816/PED102111-120
  21. Vetrov VV, Ivanov DO, Reznik VI, et al. Efferentnaya terapiya v prolongirovanii beremennosti pri mnogoplodii posle rozhdeniya pervogo ploda (dva klinicheskikh nablyudeniya). Proceedings of the XI International Scientific-Practical Internet Conference “Sostoyanie zdorov’ya: meditsinskie, sotsial’nye i psikhologo-pedagogicheskie aspekty”. Archives of Experimental and Clinical Medicine. Donetsk; 2020(Suppl. 2):50. (In Russ.)
  22. Vetrov VV, Ivanov DO, Reznik VA, et al, Metody efferentnoi terapii (ET) v profilaktike perinatal’nykh poter’ v 22–28 nedel’ beremennosti. Proceedings of the XIV Regional Scientific Image Forum “Mother and Child”. Moscow; 2021. p. 10–11. (In Russ.)
  23. Vetrov VV, Ivanov DO, Reznik VA, et al. Novaya model’ profilaktiki i lecheniya tyazheloi gemoliticheskoi bolezni ploda i novorozhdennogo (GBPN) pri rezus-immunizatsii beremennykh. Proceedings of the XXII All-Russian Scientific and Educational Forum “Mother and Child – 21”. Moscow; 2021. p. 10–11. (In Russ.)
  24. Vyugov MA. Efferentnaya terapiya v profilaktike i lechenii tyazhelykh form gemoliticheskoi bolezni novorozhdennykh pri rezus-konflikte. [Dissirtation]. Saint Petersburg; 2018. 136 p. (In Russ.) Available from: https://www.dissercat.com/content/efferentnaya-terapiya-v-profilaktike-i-lechenii-tyazhelykh-form-gemoliticheskoi-bolezni-novo. Accessed: 2022 March 18.
  25. Glushenkova VA, Tsybulskaya IS, Sukhanova LP. Problemy perinatal’noi smertnosti v Rossii. Manager Zdravoohranenia. 2007;(9):49–51. (In Russ.)
  26. Delarue NV. Vykhazhivanie nedonoshennykh detei s ekstremal’no nizkoi massoi tela: otnoshenie vrachei-neonatologov stanovitsya bolee pozitivnym. Russian Bulletin of Perinatology and Pediatrics. 2018;63(4):143. (In Russ.)
  27. Demographic Yearbook of Russia. Мoscow; 2017. (In Russ.) Available from: https://rosstat.gov.ru/folder/210/document/13207. Accessed: 2022 March 18.
  28. Zavidenko NI, Davydova LA. Prematurity and low birth weight as risk factors for neuropsychiatric development. Russian Bulletin of Perinatology and Pediatrics. 2018;63(4):43–51. (In Russ.) doi: 10.21508/1027-4065-2018-63-4-43-51
  29. Ivanov DO, Surkov DN, Editors. Osobennosti okazaniya meditsinskoi pomoshchi detyam, rodivshimsya v srokakh gestatsii 22–27 nedel’. Saint Petersburg; 2013. 132 р. (In Russ.)
  30. Ivanov DO, Shevtsova KG. Analysis of selected statistical indicators of the Northwestern Federal District in the aspect of infant mortality and stillbirth. Pediatrician (St. Petersburg). 2018;9(2):5–15. (In Russ.) doi: 10.17816/PED925-15
  31. Klinicheskie rekomendatsii. Vnutripechenochnyi kholestaz pri beremennosti (utverzhdennye Minzdravom Rossii). Moscow; 2020. (In Russ.)
  32. Klinicheskie rekomendatsii. Preeklampsiya. Eklampsiya. Oteki, proteinuriya i gipertenzionnye rasstroistva vo vremya beremennosti, v rodakh i poslerodovom periode (utverzhdennye Minzdravom Rossii). Moscow; 2021. (In Russ.) Available from: https://legalacts.ru/doc/klinicheskie-rekomendatsii-preeklampsija-eklampsija-oteki-proteinurija-i-gipertenzivnye-rasstroistva/
  33. Komkova GN, Basova AV. Medical and legal problems of nursing children with extremely low body weight. Russian Bulletin of Perinatology and Pediatrics. 2020;65(2):99–103. (In Russ.) doi: 10.21508/1027-4065-2020-65-2-99-103
  34. Kulakov VI, Serov VN, Abubakirova AM, et al. Klinicheskaya transfuziologiya v akusherstve, ginekologii i neonatologii. Мoscow; 2001. Р. 336. (In Russ.)
  35. Lebedev AS, Gazazyan MG, Kenya AN, Kuznetsova LM. Perinatal’nye poteri po Kurskoi oblasti za 15 let. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow, 2013. P. 489. (In Russ.)
  36. Moiseeva K. Some results of the assessment of the dynamics of morbidity of newborns in maternity care organizations. Medicine and healthcare organization. 2019;4(3):40–47. (In Russ.)
  37. Ondar EA. Infant mortality in the Republic of Tuva. Proceedings of the II All-Russian Conference with international participation “Perinatal medicine from prenatal preparation to healthy motherhood and childhood”. St. Petersburg; 2016. Р. 29. (In Russ.)
  38. Pechenkina NS, Svintsova NV. Monitoring prichin prezhdevremennykh rodov. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 156. (In Russ.)
  39. Pospelova YaY, Kosovtsova NV, Pavlichenko MV, et al. Twin-to-twin transfusion syndrome. Analysis of outcomes after fetoscopic laser photocoagulationof placental anastomoses. Russian Bulletin of Obstetrician-Gynecologist. 2019;19(4):22–28. (In Russ.) doi: 10.17116/rosakush20191904122
  40. Rybkina NL. Some resultant indicators of the effectiveness of neonatology service. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 455. (In Russ.)
  41. Savelyeva GM, Kulakov VI, Serov VN, et al. Modern approaches to the diagnosis, prevention and treatment of gestosis: Methodological Recommendations No. 99/80. Мoscow; 2000. 29 р. (In Russ.)
  42. Savelyeva GM, Serov VN, Sukhikh GT. Obstetrics and Gynecology. Clinical guidelines. 4th edition, revised and supplemented. Serov VN, Sukhikh GT, editors. Мoscow; 2015. 1024 p. (In Russ.)
  43. Serov VN, Frolova OG. Organizatsiya akusherskoi pomoshchi. In: Guide to Perinatology. Ivanov DO, editor. Saint Petersburg; 2015. Р. 18–35. (In Russ.)
  44. Serov VN, Frolova OG. Organizatsiya akusherskoi pomoshchi. In: Guide to Perinatology, 2nd edition. Ivanov DO, editor. Saint Petersburg; 2019. Vol. 1, Ch. 3. Р. 138–155. (In Russ.)
  45. Strizhakov AN, Timokhina EV, Ignatko IV, et al. Patofiziologiya ploda i platsenty. Мoscow; 2015. 176 p. (In Russ.)
  46. Suverneva AA, Mamiev OB. Nekotorye aspekty antenatal’nykh i intranatal’nykh poter’. Proceedings of the XIII All-Russian Scientific Forum “Mother and Child”. Moscow; 2012. P. 182. (In Russ.)
  47. Suverneva AA, Mamiev OB, Galkina NN. Retrospektivnyi analiz faktorov riska u zhenshchin s neblagopriyatnymi perinatal’nymi iskhodami. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 471. (In Russ.)
  48. Sudakov AG, Samokhvalov VA, Shalnev VV, et al. Perinatal’nyi konsilium. Zadachi, funktsii, problem. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 499. (In Russ.)
  49. Surenkova IN, Suslova GA, Skoromets AP. About the system of rehabilitation of premature babies in St. Petersburg, the concept of walking distance. Pediatrician (St. Petersburg). 2016;7(2):140–144. (In Russ.) doi: 10.17816/PED72140-144
  50. Sukhanova LP. Perinatal’naya situatsiya v sovremennoi Rossii. Sotsial’nye aspekty zdorov’ya naseleniya. (In Russ.) Available from: http://vestnik mednet/content/View/32/30/.
  51. Sukhanova LP, Sychenkov YG. Otsenka chastoty rozhdeniya i vyzhivaemosti detei s ekstremal’no nizkoi massoi tela. Proceedings of the XIII All-Russian Scientific Forum “Mother and Child”. Moscow; 2012. P. 455. (In Russ.)
  52. Sukhanova LP. New birth criteria: perinatal and demographic results. Proceedings of the XIV All-Russian Scientific Forum “Mother and Child”. Moscow; 2013. P. 506. (In Russ.)
  53. Uznova AN, Onischenko NA. Analysis of the perinatal risk causes and the structure of pathology in premature children in Chelyabinsk, born with extremely low and very low body weight. Russian Vestnik of Perinatology and Pediatrics. 2019;64(4):92–98. (In Russ.)
  54. Frolova OG, Grebennik TK, Ryabinkina IN. Statistika prezhdevremennykh rodov pri novoi sisteme ucheta rozhdenii. Proceedings of the VII Regional Scientific Forum “Mother and Child”. Moscow; 2014. P. 370. (In Russ.)
  55. Chernobay EG, Skopets VV, Nepso YR. Klinicheskii opyt primeneniya MIFEPRISTONA s tsel’yu induktsii rodov u beremennykh s rubtsom na matke i antenatal’noi gibel’yu ploda v statsionare kraevogo urovnya. Proceedings of the VII Regional Scientific Forum “Mother and Child”. Moscow; 2014. P. 165. (In Russ.)
  56. Shogenova FM, Uzdenova ZKh, Tkhabisimova IK. Analiz osnovnykh mediko-demograficheskikh pokazatelei v Kabardino-Balkarii. Proceedings of the XVI Regional Scientific Forum “Mother and Child”. Moscow; 2015. Р. 258. (In Russ.)
  57. Yakovleva OV, Bobrysheva EV. Itogi primeneniya novykh kriteriev protokola “Prezhdevremennye rody”. Proceedings of the XIII All-Russian Scientific Forum “Mother and Child”. Moscow; 2012. P. 209. (In Russ.)
  58. Bock J.E. Intrauterine transfusion in severe rhesus hemolytic disease. Acta Obstet. Gynecol. Scand. 1976;55(S53): 37–40. doi: 10.3109/00016347609156443.
  59. Bowman JM, Friesen RF. Multiple intraperitoneal transfusions of the fetus for erythroblastosis fetalis. N Engl J Med. 1964;271:703–707. doi: 10.1056/NEJM196410012711403
  60. Branda RF, Moldow CF, McCullough JJ, et al. Plasma exchange in the treatment of immune disease. Transfusion. 1975;15(6):570–576. doi: 10.1046/j.1537-2995.1975.15676082232.x
  61. Clarke CA, Elson CJ, Donohoe WT, et al. Intensive plasmapheresis as a therapeutic measure in rhesus immunized women. Lancet. 1970;1(7651):793–798. doi: 10.1016/s0140-6736(70)92406-2
  62. Förster JG, Peltonen M, Kaaja R. Plasma exchange in severe postpartum HELLP syndrome. Acta Anaesthesiol Scand. 2002;46(8):955–958. doi: 10.1034/j.1399-6576.2002.460805.x
  63. Szczepiorkowski ZM, Bandarenko N, Kim HC, et al. Red cell alloimmunization in pregnancy. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Apheresis Application Committee of the American Society for Apheresis (ASFA): The seventh special issue. Journal Clinical Apheresis. 2016;31(3):295.

Copyright (c) 2022 Ivanov D.O., Vetrov V.V., Kurdynko L.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies