Management of perinatal care during the COVID-19 pandemic in Ukraine: organizational and legal mechanism

Abstract

Introduction. The topic of maternity and childhood care is one of the most important in the health care system of Ukraine, given the importance of the issue of the birth of healthy children – the future potential of an independent state. At the beginning of the era of implementation of the Sustainable Development Goals, the morbidity and mortality of women during pregnancy and childbirth remained unacceptably high. Most of them could have been prevented. The 2019 coronavirus disease (COVID-19) pandemic significantly changed the way of life of most people and disrupted the work of specialized health care systems. Therefore, anticipating the possibility of repeated pandemics, it is necessary to analyse the experience of the functioning of the medical field at this stage and justify new approaches to the organization of high-quality medical perinatal care in the conditions of possible repeated outbreaks of infection. Isolation of previously unresolved parts of the general problem. Although there is much published scientific literature on various aspects of the organization of perinatal care, there is almost no literature on how management approaches to women's routine prenatal care have changed and how the system has been reorganized during the pandemic in Ukraine. Results. The effectiveness of Ukrainian health care system, which has historically been built on face-to-face interactions between patients and health care providers, has suffered severely. And it is not only in Ukraine. Healthcare systems of all countries, especially those with limited financial resources, are facing a challenge. Pregnant women are particularly vulnerable to respiratory pathogens due to physiological changes in the immune and cardiorespiratory systems and may be at increased risk of severe disease. In this regard, it is extremely important to reorganize the system of prenatal visits not only to reduce the possibility of contact of a healthy pregnant woman with infected people, but also to minimize the contact of medical workers with patients who may be infected. International experience shows that during this COVID-19 pandemic, some countries have decided to reduce the number of in-person antenatal visits to only three (for example, Australia) or four (as recommended by the WHO) for low-risk women throughout pregnancy. For Ukraine, a model of prenatal care has also been proposed as a quick response to combating the spread of infection. According to this model, when monitoring a pregnant woman in an outpatient setting, all consultations that do not require testing and ultrasound should be conducted remotely (video consultations or telephone consultations). Pregnant women must be referred to a specialized maternity hospital, designated by the Department of health care of Regional State Administration, to provide assistance to pregnant women with suspected or confirmed COVID-19 infection in clearly defined cases. We emphasize: the main conditions for the introduction of such a model in Ukraine are a well-established system of medical services using telemedicine, as well as a well- thought-out information campaign. And the foundations for its implementation are already laid in the branch state policy and legislation. In the event of an epidemic or an outbreak of an infectious disease, the media, regardless of the form of ownership, assist the executive authorities and local self- government bodies in carrying out the necessary explanatory work among the population, regarding the dangers of self-medication. According to the results of our study, conducted based on the Lviv Regional Clinical Perinatal Centre, in which 535 women in labour were interviewed, it was established that 22 percent of the surveyed women took medication for the prevention of COVID-19. Conclusion. Health care facilities should develop plans to minimize exposure to healthy pregnant women while continuing to provide both routine and emergency obstetric care. Telemedicine can play an important role in updating healthcare systems during the outbreak of COVID-19 cases. Even though such digital technologies have existed for decades and are already at the advanced stage of implementation in some areas, they are still minimally studied for obstetric care. Therefore, the following key components are needed to rapidly deploy an antenatal care model in response to the COVID-19 pandemic: 1) a locally approved antenatal care program; 2) a developed algorithm for monitoring pregnant women with suspected or confirmed diagnosis of COVID-19; 3) provision of equipment and Internet supply to healthcare institutions; 4) staff training; 5) informing the population.