MODERN APPROACHES TO CAESAREAN SECTION AT THE THIRD LEVEL OF PERINATAL CARE

Abstract

Between 2015 and 2020, the incidence of abdominal delivery in Ukraine increased annually and reached 26.7% of the total number of births in 2021. In Poltava Region, in 2022, the rate of caesarean delivery reached an all-time high of 28.7%. To outline the tendencies in providing quality obstetric care and to identify ways to reduce the frequency of abdominal delivery in the Poltava region, there has been conducted a statistical analysis of the annual reports for the period from 2017 to 2022 obtained from the perinatal centre of the M.V. Sklifosovskyi Poltava Regional Clinical Hospital and reports on medical care for pregnant women, women in labour, newborns and children in the first year of life (forms No. 21 and No. 21-a) from the Health Department of the Poltava Regional State Administration. The data show a notable rise in the percentage of abdominal deliveries in 2022 in hospitals of the first and second levels of perinatal care, with a 4% decrease in the share of caesarean deliveries at the third level hospitals, which primarily deal with patients having severe obstetric and extragenital pathologies. For instance, in 2022, more than one out of four women (25.7%) was reported as having caesarean delivery at the Municipal Clinical Maternity Hospital of Poltava, and one in three women (33.6%) was reported to have surgical delivery at the Kremenchuk Perinatal Centre of the second level. Since 2018, the average rate of caesarean sections performed as the level I obstetric hospitals in Poltava Oblast has been progressively rising and in 2022 reached 23.9% of all surgical interventions in the region. Conversely, in the perinatal centre of the M.V. Sklifosovskyi Poltava Regional Clinical Hospital, the number of abdominal deliveries has been decreasing annually, and in 2022 this figure was 35.8%. Notably, this decrease in abdominal delivery coincided with a reduction in the perinatal mortality rate, which declined from 22.06‰ in 2018 to 14.51‰ in 2022. Thus, the key strategy for reducing the rate of caesarean deliveries in the Poltava region lies in the adherence to regional peculiarities and requirements of perinatal care that entail timely referral of pregnant women at high risk of maternal and infant complications to the third level settings of perinatal care, where the decision regarding caesarean delivery can be appropriately assessed, ensuring a balanced approach that minimizes both the overall incidence of abdominal deliveries and perinatal mortality.