Obstetric Institutions Research Articles

Staffing of anaesthesiology and resuscitation services in obstetric hospitals the Russian Federation

Introduction. One of the strategies for reducing maternal mortality is to improve the provision of medical care to pregnant women, women in labor and maternity hospitals in need of intensive care. Sufficient provision of anesthesiology and intensive care units of maternity institutions with highly qualified personnel is the most important factor determining the availability and quality of medical care for women. The purpose of the study: to analyse the staffing of the anaesthesiology and resuscitation services of obstetric hospitals in the Russian Federation. Materials and methods. Based on the data of 83 subjects of the Russian Federation, the indicators of staffing (per 10,000 women of fertile age) with anaesthesiologists-resuscitators (for 2007–2022) and nurses anaesthesiologists (for 2021–2022), staffing levels and compatibility ratios of anaesthesiologist-resuscitators and nurses anaesthesiologists in obstetric hospitals of group II and III (level) (for 2022) in the Russian Federation, federal districts and subjects of the Russian Federation were analysed. Based on data from 29 subjects of the Russian Federation (for 2021), the average age of anaesthesiologists-resuscitators and nurses anaesthesiologists working in obstetric hospitals was analysed. Results. In 2007–2022, the number of anaesthesiologists-resuscitators in obstetric hospitals of the Russian Federation increased by 27.2 %, and the availability of anaesthesiologists-resuscitators (per 10,000 women of fertile age) increased by 43.9 %. The number of nurse anaesthesiologists in obstetric hospitals in 2021–2022 increased by 0.8 %, the availability of nurse anaesthetists (per 10,000 women of fertile age) decreased by 0.8 %. In 2022, the staffing level of anaesthesiologists-resuscitators in obstetric hospitals of Group II was 85.6 %, Group III – 86.0 %, and nurses anaesthesiologists – 87.8 % and 88.4%, respectively. The compatibility rate of anaesthesiologists-resuscitators in obstetric hospitals of group II was 1.42, group III – 1.53, and nurse anaesthesiologists – 1.23 and 1.34 respectively (2022). The average age of anaesthesiologists-resuscitators working in obstetric hospitals was 43.3 ± 4.3 years, nurse anaesthesiologists – 42.1 ± 3.9 years (2021). Conclusion. In order to eliminate staff shortages, it is necessary to implement measures to attract medical staff in the anaesthesiology and resuscitation services of obstetric institutions, which will decrease the burden on medical staff and prevent maternal deaths.

ОЦЕНКА ГОТОВНОСТИ БУДУЩИХ МАМ К ГРУДНОМУ ВСКАРМЛИВАНИЮ

Breastfeeding is the optimal type of child feeding, having a beneficial effect on the health of the child and mother. Objective: to assess the knowledge of expectant mothers about breast milk and the current practice of preparing for breastfeeding in medical organizations. Materials and methods. A one-time study was conducted using a voluntary survey among pregnant and postpartum women in antenatal clinics and obstetric institutions. Results. Despite the readiness of 89% of surveyed respondents to breastfeed their children, there is insufficient commitment of medical personnel to prepare for breastfeeding: only 44% of expectant mothers received information about the benefits of breastfeeding during pregnancy in antenatal clinics and 68% in maternity care institutions, attached to breasts immediately after birth in only 73% of newborns, only 29.6% of postpartum women received help from a breastfeeding consultant in the maternity hospital, 39% of nursing mothers developed cracked nipples on the second or third day from the start of feeding, indicating a violation of breastfeeding technique, and finally, only 33.0% of mothers in the region breastfeed until their children reach 6 months of age. Only 7.3% of respondents know about the reduced risk of developing breast cancer when breastfeeding, 26% believe that children receiving adapted artificial formula are less susceptible to acute intestinal infections. Conclusion. Insufficient knowledge about the benefits of breast milk in expectant mothers requires a change in organizational forms of work to support breastfeeding during pregnancy and in the early postpartum period in medical organizations, as well as large-scale measures to inform the population and create conditions conducive to breastfeeding about its importance.

Assessment of the impact of COVID-19 experienced at different stages of gestation on perinatal outcomes and structural changes in the placenta

BACKGROUND: At the beginning of the pandemic COVID-19, the attention of obstetricians and gynecologists was focused on studying the impact of SARS-CoV-2 on obstetric and perinatal outcomes. Currently, the dynamics of mutations in genes encoding SARS-CoV-2 proteins determines the emergence of a large number of new strains of the virus that are highly virulent. Given this fact, the problem of assessing the impact of COVID-19 on pregnancy outcomes also remains relevant.
 AIM: The aim of this study was to assess the impact of the novel coronavirus infection (COVID-19) transmitted at different stages of gestation on perinatal outcomes and structural changes in the placenta.
 MATERIALS AND METHODS: In 2022–2023, a prospective analysis of 113 cases of childbirth in women who had the novel coronavirus infection during pregnancy was carried out in obstetric institutions in Novosibirsk. The total sample of subjects was divided into three study groups using cluster analysis. Group 1 included 25 women who had SARS-CoV-2 at a gestation period of up to 16 weeks; Group 2 consisted of 61 patients who underwent COVID-19 at gestation period of 17 to 34 weeks; and Group 3 comprised 27 pregnant women in whom COVID-19 was detected after 34 weeks of pregnancy. The control group included 65 pregnant women who had a negative smear test result for SARS-CoV-2. Pathological examination of the placenta included macro- and microscopic studies. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 program.
 RESULTS: The most common fetal distress was observed in patients of Groups 1 and 2 (p = 0.002). We found an inverse correlation between the gestational age at which a woman suffered coronavirus infection and the volumetric density of capillaries and intervillous fibrinoid, as well as the percentage of formation of the syncytial-capillary membrane and villi with symplastic buds. On the contrary, a direct correlation between the gestational age and the volumetric density of connective tissue was found. Intervillusitis was more often observed in the placentas of women of Groups 1 and 2. Histitocytic infiltration was characteristic of the placentas of patients of Group 2.
 CONCLUSIONS: The frequency of adverse perinatal outcomes and the intensity of structural changes in the placenta depend on the gestation period in which the patient suffered the novel coronavirus infection. The most significant structural changes in the placenta were detected in patients of Group 2.

Neurovegetative responses in medical staff of maternity institutions

Introduction. Factors of the labour process influence on the adaptive capabilities of the cardiovascular and autonomic nervous systems in workers. 
 Purpose of the study. The study of the possible relationship between the indicator of adaptation of regulatory systems of heart rate variability and the intensity of the labour process in doctors and nurses in obstetric institutions of the second and third levels. 
 Materials and methods. The intensity of the labour process was determined by the method of timing. To calculate the adaptation index in the trend in the work shift, the hardware-software complex “Varicard 2.51” was used. Two hundred twenty eight doctors and nurses were examined. The studies were carried out on the basis of obstetric institutions of the second and third levels of the cities of the Central Federal District: Ryazan, Kolomna, Lipetsk, Smolensk. Statistical processing of research results was carried out using standard methods (p<0.05). 
 Results. The studies were carried out on the basis of obstetric institutions of the second and third level in some cities of the Central Federal District: Ryazan, Kolomna, Lipetsk, Smolensk. The data obtained in the study of the peculiarities of the regulatory potential in medical workers of various occupational groups made it possible to get an idea of ​​the influence of the factors of the labour process on the adaptive resources, assessed by the indicators of the temporal analysis. The data obtained made it possible to identify a direct correlation between the intensity of the labour process and the developing neurovegetative responses of the organism, which were reflected in the adaptation index in ccupational groups of obstetrician-gynecologists, nurse anesthetists, and midwives of perinatal centers. 
 Limitations. The studies were carried out in small groups taking into account the trend in the work shift, which opens up the prospect of studying the issue in the age aspect in large groups.
 Conclusion. The results of the study can be used to develop evidence-based recommendations for the prevention of occupationally conditioned overstrain of the organism’s adaptive systems.

Prenatal Care Shopping: Paying for Reproductive Peace of Mind in Taiwan

ABSTRACT This article discusses people’s experiences of prenatal screening and testing (PST) in Taiwan, a country that offers an extensive schedule of free PST underpinned by a ‘Eugenic Health’ Law that promotes the idea of you sheng [superior birth]. Conducting periods of fieldwork from 2008 to 2021, and undertaking 114 ethnographic interviews with women, their partners and clinicians, we observed that pregnant women were often anxious about the health of the foetus, and that their anxieties were not reduced by engaging with new prenatal genetic testing technologies: on the contrary, such engagements increased their levels of concern. In order to address these worries, many participants repeatedly visited different obstetric institutions and clinicians, purchasing multiple forms of genetic screening and testing: we call this ‘prenatal care shopping’. Many participants also visited temples to pray and make offerings to try to gain ‘peace of mind.’ In exploring these prenatal care shopping and spiritual activities, we analyse how our participants situate themselves in relation to PST technologies and ask what is the significance of their experiences for policy-makers in the reproductive health space in Taiwan and more broadly?

Epidemiology of hepatitis C infection among pregnant women and parturients in Nizhny Novgorod

Hepatitis C is an urgent global health problem. The high prevalence of infection among the population leads to the involvement of women of reproductive age in the epidemic process. In order to study the prevalence of specific markers of hepatitis C virus in pregnant women and to assess the risk of intrauterine infection of the fetus, an epidemiologic analysis was conducted using information collections of statistical and analytical materials of Rospotrebnadzor, blood serum samples of pregnant and postpartum women (n = 28394) at admission to obstetric institutions for the period 2018–2022 were examined. According to statistical reporting, the average annual prevalence of anti-HCV prevalence in pregnant women was 1.7% (95% CI: 1.5–1.9%). Women aged 40–49 years were found to be most actively involved in the epidemic process (4.3% [95% CI: 3.3–5.6%]). Among anti-HCV-positive samples, HCV RNA was detected in 47.0% (95% CI: 41.7–52.9%) of cases, the prevalence of current infection confirmed by HCV RNA detection in pregnant women was 0.9% (95% CI: 0.8–1.0%). The pattern of HCV genotypes in pregnant women was as follows: subtype 1b was detected in 34.9% (95% CI: 25.6–45.7%) of cases, subtype 3a in 42.2% (95% DI: 32.1–52.9%), minor subtype 1a was 9.6% (95% CI: 5.0–17.9%) and genotype 2 was 7.0% (95% CI: 3.4–14.9%). Samples containing two genotypes simultaneously (1a/1b, 1b/3a) were 3.6% (95% CI: 1.2–10.1%) and non-genotyped samples were 2.4% (95% CI: 0.7–4.1%). The results of the assessment of the significance of risk factors for perinatal transmission of hepatitis C virus show a high degree of influence on vertical transmission of HCV RNA in the presence of active infection in the mother (RR = 6.4; [95% CI: 0.9–44.6%]: p < 0.05), no statistical significance of HCV genotypic affiliation (p > 0.05) and maternal viral load level (R = 0.00009; p > 0.05). The obtained data argue the necessity of screening examinations for molecular genetic markers of hepatitis C virus in women planning pregnancy in order to conduct antiviral therapy and, as a consequence, to reduce the risk of perinatal infection of children.

Prevention of bladder damage during repeated caesarean sections

Repeated cesarean section operations are becoming a daily practice in obstetric institutions of the 2nd and 3rd groups. With each subsequent operation, due to adhesions or infectious complications (obstetric peritonitis), the risks of injuries to organs adjacent to the uterus increase. Objective: development of a method for preventing to the bladder injury during repeated cesarean section operations. Materials and methods: Prospective cohort studies were performed in 320 patients with the scar after Caesarean Section who underwent a repeated cesarean section: 186 patients were operated in plan and 134 in urgent situation. All patients had given the hydropreparation of paravesical tissue by 0.5 % solution of novocaine 20 ml, which was injected under the vesicouterine fold from the side of the round ligaments for the prevention injury of bladder. Statistical processing was carried out using the Statistica 13 package. Results and discussion: With partial mobilization of the posterior wall, bladder injury in group 1 was in 2 patients, in group 2 in 4 patients (2 = 1.544, p = 0.215). The injury of the bladder walls in group 2 occurred in patients operated on for obstetric peritonitis and was caused by pronounced infiltration of paravisical tissue and inflammatory changes in the lower segment of the uterus. Conclusions: The developed method by hydropreparation the paravesical tissue allows minimizing the number of bladder injuries with a pronounced adhesive process in the lower segment of the uterus or tissue infiltration with purulent-inflammatory complications.

Medical care for postpartum bleeding: A literature review

Relevance: According to modern literature, over the past decade, there has been no tendency in the world to reduce maternal mortality from postpartum hemorrhage (PPH). In Kazakhstan, evidence-based medicine clinical recommendations on prevention and algorithm of action for obstetric bleeding have been developed and recommended for use since 2010. We conducted a literary search for existing innovative methods of PPH prevention and treatment based on the study of clinical recommendations of many developed countries, WHO, FIGO, and scientific publications. There exist separate algorithms for managing PPH during vaginal delivery or cesarean section.The study aimed to explore the existing innovative methods of preventing and treating postpartum hemorrhage to determine the most effective medical care for postpartum hemorrhage.Materials and methods: The literature search included papers published on PubMed in English from January 1, 2018, to November 31, 2022. The search was done by keywords including “pregnancy,” “PPH,” “pregnancy complication,” “pregnancy outcomes,” and “tranexamic acid,” “guideline.” Results: Today, there are separate algorithms for managing PPH during vaginal delivery or cesarean section. Fibrin preparations and fibrinogen concentrate are recommended for use. When PPH occurs, it is important to communicate with family members to further inform them about the patient’s condition. The routine use of the Allgower shock index for accurate calculation of the volume of blood loss is proposed. It is proposed to use antifibrinolytic drugs not only for therapeutic purposes but also for prophylactic purposes. It is important to carry out adequate infusion-transfusion therapy to prevent iatrogenic coagulopathy. Conclusion: Introducing the above modern technologies into practical healthcare does not require high economic costs and can be used in obstetric institutions at all levels of medical care for PPH.

Developing an obstetric care screening tool to improve social support access for pregnant women: A prospective cohort study.

This study aimed to develop an efficient interview sheet during pregnancy and screening tool to identify pregnant women needing social support at obstetric institutions. Moreover, we investigate the perinatal factors associated with the Edinburgh postnatal depression scale (EPDS). This prospective cohort study was conducted at three medical institutions that commonly encounter cases with social issues. Pregnant women were assessed using an interview sheet at the first visit (n = 678), at approximately 28 weeks gestation (n = 495), 36 weeks gestation (n = 296), and the postpartum period (n = 822). We investigated the important items identified on the new screening questionnaire (NEW interview sheets) for women needing social support. The items on the interview sheet were scored by multiple linear regression analysis, and the cutoff values were calculated using the receiver operating characteristic curve. The association between perinatal factors and EPDS was assessed using multiple logistic regression analyses. The study included 166 cases for which all NEW interview sheets for all periods were available. NEW interview sheets and stepwise screening tools during the first and second trimester were developed in which 2.5% of pregnant women were identified as requiring social support, respectively. The factors associated with EPDS ≧ 9 were "Women who felt confused/troubled or did not feel anything to be pregnant" (adjusted odds ratio [aOR]: 6.51, 95% confidence interval [CI]: 1.62-26.15), "Maternal mental disorder" (aOR 4.38; CI 1.06-18.10), "Consultation request at first visit" (aOR 3.22; CI 1.09-9.45), and "Women who have difficulty or anxiety about pregnancy during the second trimester" (aOR 3.14; CI 1.29-7.67). We created the NEW interview sheets and screening tools during the first and the second trimester. Future studies are needed to validate these screening tools.

Факторы риска антенатальной гибели плода у беременных женщин с отягощенным акушерским анамнезом, перенесших COVID

Objective. To investigate the significance and prognostic value of risk factors for intrauterine fetal demise (IUFD) in women with complicated obstetric history (COH) who had COVID-19 in the second and third trimesters of pregnancy. Patients and methods. A retrospective study of 5027 medical records of pregnant women, postpartum women and neonates who received treatment in obstetric institutions in Almaty with positive PCR results for SARS-CoV-2 in the second and third trimesters of pregnancy was conducted. IUFD occurred in 46 (0.9%) pregnant women. Results. The risk of IUFD increased with prolongation of COVID-19 treatment during pregnancy (OR = 8.673, 95% CI: 4.252-17.692), in the absence of therapy with low-molecular-weight heparin (OR = 4.835, 95% CI: 2.471-9. 459) and was also characteristic of moderate and severe COVID-19 (OR = 4.2667, 95% CI: 1.0603-17.1689), with history of maternal anemia and acute respiratory viral infections (ARVI) (OR = 3.524, 95% CI: 1.643-7.559 and OR = 4.117, 95% CI: 1.881-9.010, respectively). Meanwhile, the absence of antibiotic and corticosteroid therapy was associated with a lower risk of IUFD (OR = 0.415, 95% CI: 0.184-0.937 and OR = 0.278, 95% CI: 0.142-0.547, respectively). Conclusion. The risk of IUFD in pregnant women with COH and COVID-19 during pregnancy increased significantly with the duration of COVID-19 treatment, with moderate and severe course, and with the deficiency of anticoagulant therapy. At the same time, the absence of glucocorticosteroids and antibacterial agents showed a negative association with IUFD. Key words: intrauterine fetal demise, antibiotic therapy, anticoagulants, pregnancy, glucocorticosteroid therapy, COVID-19

Congenital Cytomegalovirus Infection and Maternal Primary Cytomegalovirus Infection in Universal Newborn Hearing Screening Referral Patients: A Prospective Cohort Study

Background: There are no detailed reports in the literature on maternal cytomegalovirus antibody screening for universal newborn hearing screening (UNHS) referral patients. We examined maternal cytomegalovirus antibody screening results and estimated the incidence of maternal primary cytomegalovirus infection among UNHS referral patients. Methods: During September 2013–March 2021, fresh urine samples were collected in the first week after birth from 98 neonates with UNHS referral results at 15 obstetrical institutions in Mie, Japan (the first hearing screening). We performed a real-time polymerase chain reaction analysis to detect cytomegalovirus DNA in the samples. Infants with ≥200 copies/mL of cytomegalovirus DNA were diagnosed with congenital cytomegalovirus (cCMV) infection. A second hearing screening was performed, and patients with positive results were sent to the otorhinolaryngologists for further examinations of congenital hearing loss. We calculated incidence rates (%) with 95% confidence intervals (CIs) for cCMV infection among patients with UNHS referral results and maternal primary cytomegalovirus infection among patients who underwent maternal cytomegalovirus antibody screening. Results: Among the 98 neonates with UNHS referral results (the first hearing screening), 5 were diagnosed with cCMV infection (incidence rate: 5.1%; 95% CI: 0.8–9.5). All five patients with cCMV had positive second hearing screening results and were sent to their otorhinolaryngologists. All five were diagnosed with congenital hearing loss, and four were diagnosed with congenital hearing loss secondary to cCMV infection. The remaining patient with cCMV infection was diagnosed with congenital hearing loss unrelated to cCMV infection. Of the 98 patients, 60 underwent maternal cytomegalovirus antibody screening. Among the 60 patients, six had maternal primary cytomegalovirus infection during pregnancy (incidence rate: 10.0%; 95% CI: 2.4–17.6). Of the six patients, four were positive for cytomegalovirus immunoglobulin (CMV Ig) G and IgM antibodies in maternal blood with low CMV IgG antibody avidity results during early pregnancy, while the remaining two had maternal CMV IgG antibody seroconversion during pregnancy. Conclusions: This is the first study to examine the maternal primary cytomegalovirus infection incidence rate in patients with UNHS referral results (the first hearing screening). We identified a 10-fold higher risk in this population (10.0%) than in the general population (0.98%).

Relationship between Child Care Exhaustion and Breastfeeding Type at Two and Six Months in a Cohort of 1210 Japanese Mothers.

This study investigated whether parenting stress is associated with breastfeeding type (exclusive or partial). Between 2014 and 2019, we recruited 1210 healthy mothers (mean age, 31.2 years; 65%, multiparity) from 73 obstetric institutions across all prefectures of Japan. Among these, 1120 mothers at two months and 1035 mothers at six months were investigated for parenting stress and breastfeeding type: exclusive versus otherwise (partial). Parenting stress was measured by a validated Japanese scale consisting of childcare exhaustion, worry about child’s development, and no partner support. Exclusive breastfeeding prevalence was 75% at two and 78% at six months. The total scores for childcare exhaustion and worry about child development were statistically higher in the partial breastfeeding group than in the exclusive breastfeeding group at two months but not at six months. A logistic regression model demonstrated that childcare exhaustion was significantly associated with an increased risk of having partial breastfeeding at two months after adjusting for the maternal Body Mass Index, parity, and baby’s current weight. However, the association was no longer significant at six months. The present study suggests that intervention for parenting stress at two months postpartum may promote prolonged exclusive breastfeeding.

Current strategies for the prevention of RDS in premature infants and possibilities of using them in the RT

Aim. To analyze modern strategies for the prevention of respiratory distress syndrome and the possibility of their use in RT.Material and methods. The analysis was carried out based on directives of the Government of the Republic of Tajikistan, regulations, and normative documents for obstetric institutions approved by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, and the data from annual reports of structural units.Results. The paper outlines an approach to monitoring a pregnant woman based on the 5th updated European Consensus Guidelines for the Management of Newborns with Respiratory Distress Syndrome. It presents positive and negative arguments for the effect of steroid drugs on the fetus and recommendations for their use at the stage of management of pregnant women with a high risk of preterm birth, depending on the gestation period. It also includes a brief comparative analysis with national clinical protocols for the management of preterm labor and tocolytic therapy.Conclusion. Early identification of pregnant women at high risk of termination and providing them with effective care following modern strategies, reduce the adverse perinatal outcomes.

Media use in gynecological and obstetric care and women’s perceived level of education received of lifestyle-related risks: A cross-sectional study

Objective:The application of media on lifestyle-related risk factors (LRRFs) by healthcare providers to educate women may improve women’s adherence, health literacy, and awareness of LRRFs, as well as offspring’s health outcomes. This study investigated whether exposure to media-based education in gynecological and obstetric care is associated with LRRFs perceived levels of education received during pregnancy and lactation.Methods:We conducted a cross-sectional, observational study across 14 randomly generated sample points in the 12 most populated cities in Baden-Württemberg, southwest Germany. Women were recruited from gynecological and obstetric institutions. Participants were 219 women who met our inclusion criteria and completed the quantitative questionnaire. We applied ordinal logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of women’s perceived level of education received related to healthcare providers’ exposure to media-based education.Results:Media-based education on LRRFs during pregnancy through gynecologists and/or midwives were significantly associated with women’s perceived level of education received (gynecologists: OR = 4.26 (95% CI: 2.04, 8.90; p < .001); midwives: OR = 3.86 (95% CI: 1.66, 8.98; p = .002)). Similar results were found for media-based education through gynecologists and/or midwives on LRRFs during lactation and its association with women’s self-assessed level of perceived level of education received (gynecologists: OR = 4.76 (95% CI: 2.15, 10.56; p < .001); midwives: OR = 7.61 (95% CI: 3.13, 18.53; p < .001)).Conclusions:This study suggests that the exposure to media-based education in gynecological and obstetric care increases women’s perceived level of education received of LRRFs during pregnancy and lactation. Therefore, it is recommendable to apply media in gynecological and obstetric care settings.

CLINICAL AND LABORATORY FEATURES OF EARLY AND LATE NEONATAL SEPSIS COURSE AT THE STAGE OF OBSTETRIC INSTITUTIONS

Neonatal sepsis (NS) is the leading cause of morbidity and mortality in intensive care units. The issue of early diagnosis of a purulent-septic process in newborns using modern research methods that can be used as screening methods for verifying the diagnosis remains relevant. Objective. To conduct a comparative analysis of clinical and laboratory features of the course of early and late neonatal sepsis to optimize the early diagnosis of infectious-inflammatory process at the stage of obstetric institutions. Material and methods. To achieve this goal, retrospectively 26 medical records of newborns at the stage of obstetric institutions were analyzed, which were later transferred for treatment to the Regional Municipal Non-Profit Enterprise "Chernivtsi Regional Children's Clinical Hospital" in Chernivtsi with manifestations of generalized infectious-inflammatory process. The first group consisted of 14 (53.8%) newborns diagnosed with early neonatal sepsis; the second group included 12 (46.2%) newborns that were diagnosed with late neonatal sepsis (p &gt; 0.05). Research results. Peculiarities of the clinical manifestation of the infectious-inflammatory process should be recognized as a combination of several locus of infection, which occurred in group I in 57.1% of cases, in group II – in 16.6% of cases (p &lt; 0.05). Muffled heart sounds at the initial examination and a tendency to thermolability were more common in newborns with early NS: OR – 6.1 (95% CI 2.71–13.92), RR – 1.97 (95% CI 0.97–3.97), AR – 0.39 and OR – 3.6 (95% CI 2.01–6.46), RR – 1.89 (95% CI 1.38–2.58), AR – 0.31. Conclusion. The analysis revealed that in early neonatal sepsis the risk of detecting muffled heart sounds during auscultation (odds ratio – 6.1), unstable body temperature (odds ratio – 3.6) and absolute leukocyte count &gt; 20.0×109/L is significantly higher (odds ratio – 2.79).

Temporary characteristics of heart rate variability in medical workers of obstetric institutions

Hygienic working conditions and the labor process affect the functional state of the body of workers and reflect in the performance indicators of the cardiovascular system. The study aims to learn the temporal characteristics of heart rate variability in doctors and nursing staff of second-and third-level obstetric institutions. Scientists examined 228 people of higher and secondary medical personnel with the help of the Varikard 2.51 hardware and software complex. In the dynamics of the working shift, we studied the mean square deviation of the cardiac intervals R-R; the square root of the sum of the differences of a sequential series of NN intervals; the voltage index of regulatory systems. We researched the basis of maternity institutions of the second and third levels in some cities of the Central Federal District: Ryazan, Kolomna, Lipetsk, Smolensk. The data obtained during the study of the features of the regulatory potential of medical workers of various professional groups allowed us to understand the influence of factors of the labor process on adaptive resources, estimated by the indicators of the time analysis of heart rate variability (HRV). The researchers obtained statistically significant differences in time indicators of heart rate variability (the mean square deviation of cardiac intervals R-R; the square root of the sum of the differences of a consecutive series of NN intervals; stress index of regulatory systems) in professional groups of obstetricians, gynecologists, neonatologists, midwives, anesthesiologists, as well as ward nurses of perinatal centers and maternity hospitals in the dynamics of the work shift. It is possible to use the results of the conducted research to develop scientifically based recommendations for the prevention of professionally caused overstrain of adaptive systems of the body.

Pregnancy and childbirth in dwarf women

In the practice of large obstetric institutions, there are cases of pregnancy and childbirth in women of dwarf stature, and each such case poses a number of very difficult questions for the attending physician.

Technology for predicting abnormal labor

BACKGROUND: Abnormal labor is the most common complication of labor. It occurs in 10-15% cases of labor and is an indication for operative delivery in a third of all cases. Until now, there are no effective ways to predict abnormal labor. Meanwhile, the use of high-tech forecasting methods is not available for a wide range of obstetric institutions in the Russian Federation.&#x0D; AIM: The aim of this study was to create a technology for predicting abnormal labor, based on generally available methods of laboratory and instrumental research.&#x0D; MATERIALS AND METHODS: Based on the data collected in the Regional Clinical Hospital Perinatal Center, Chita, Russia in 2018-2021, the retrospective analysis of 200 cases of labor was carried out. The total sample was divided into four study groups: 100 women with normal labor activity (group 1), 30 women with uterine inertia (group 2), 30 women with incoordinate uterine activity (group 3), and 50 women with excessive uterine activity (group 4). The groups were comparable in terms of age, anthropometric parameters and extragenital pathology. All women on the eve of labor (1-2 days) underwent general clinical and ultrasound examination. Statistical processing of the results was carried out using the IBM SPSS Statistics version 25.0 software.&#x0D; RESULTS: The technology for predicting abnormal labor is implemented based on a multilayer perceptron, with the percentage of incorrect predictions being 21.3%. The structure of the trained neural network included nine input neurons: labor parity, gestational age, leukocyte count, erythrocyte sedimentation rate, total protein concentration, amniotic fluid index, biparietal size, as well as fetal head and abdomen circumference.&#x0D; CONCLUSIONS: An integrated approach based on generally available laboratory and instrumental research methods, such as complete blood count and biochemical blood test, as well as ultrasound examination, on the eve of labor allows for predicting the abnormal labor development with an accuracy of up to 70%. The use of this technology in clinical practice will help, in the future, not only to prevent abnormal labor, but also to reduce the incidence of adverse obstetric and perinatal outcomes.

Socio-demographic characteristics of medical personnel in parental aid institutions

The article examines the socio-demographic indicators of professional groups of medical workers, some factors of job satisfaction. Purpose of the study - socio-demographic characteristics of medical personnel in obstetric institutions for the further development of scientifically based recommendations on the formation of health-preserving behavior. The research was carried out by means of anonymous questionnaires on the basis of obstetric institutions of the second and third levels. Ryazan, Kolomna, Lipetsk, Smolensk. The study involved doctors (obstetricians-gynecologists, neonatologists) and nurses (midwives, anesthetics nurses, ward nurses). The study showed that about half of the respondents in medical professions, one tenth in the professional groups of nursing staff belong to the age category under 30 years old. The age group of 30-39 years is represented by doctors and mid-level medical personnel in almost equal proportions. In the age group 40 years and older, representatives of the nursing professions prevail. A significant part of the respondents are medical professions, have work experience in their specialty from 5 to 9 years; representatives of nursing professions, mainly, have work experience of 10-14 years and more than 15 years. In the families of nursing staff (nurse anesthetists and ward nurses), one can note dissatisfaction and incomplete satisfaction with the level of wages and lack of confidence in the future. The revealed dissatisfaction with work can lead to a decrease in motivation to perform professional duties. Socio-demographic characteristics are basic and serve as the basis for further hygienic and statistical studies, identifying correlations between unfavorable hygienic factors (physical inactivity, prolonged static load, local overstrain of certain muscle groups, exposure to physical, chemical and biological factors, psychoemotional and informational stress).

Incidence of healthcare-associated infections among puerperas and newborns in Russian Federation

One of the leading problems of modern public health is healthcare-associated infections (HAIs), which lead to significant social and economic damage, and affect the quality of medical care. The proportion of HAIs in obstetric institutions among all the Ministry of Defense of the Russian Federation for 9 years decreased by 1.7 times. The number of puerperas of HAIs decreased by 1.4 times, and HAIs of newborns decreased by 1.6 times. The proportion of puerperal sepsis in the structure of purulent-septic infections of puerperas is 1.7 ± 0.5 %, and sepsis of newborns is 4.4 ± 1.5 %. The average incidence of puerperas of IUPS was 2.0 ± 2.1 per 1,000 births. The incidence of HAIs in newborns was 2.0 ± 1.8 per 1,000 newborns. The ratio of HAIs of newborns to intrauterine infections on average was 1: 9, and in some regions 1:2–1:150. The obtained data on the incidence of HAIs in puerperas and newborns indicates the insufficiency of a systematic approach to recording, analyzing and predicting the incidence of HAIs, which requires a detailed development of standard epidemiological definitions of the case HAIs of puerperas and newborns, intrauterine infections of newborns, as well as a detailed analysis of risk factors for the development of HAIs in obstetric facilities.