CLINICO-PATHOLOGICAL PARALLELS AND CORRELACIONS BY MATERNAL MORTALITY, TANGENTIALLY RELATED TO INDIRECT OBSTETRIC CAUSES, IN CHELYABINSK REGION
In Russia extragenital diseases in the structure of maternal mortality (MM) composes from 20 to 50% of fatal outcomes.We have used the autopsy materials of the Chelyabinsk’s regional pathoanatomical office and of the Regional Office of the Chief Medical Examiner for the period of 2011-2016 as well as the original clinical medical records. The clinical pathoanatomical re-expertise of the maternal mortality cases was carried out with making the retrospective pathoanatomical diagnosis and clinical pathoanatomicalepicrisis. For the last 6 years the maternal mortality index in the Chelyabinsk region was notable for instability and in certain years it was higher than the average index in Russia. During the retrospective clinical pathoanatomical analysis of 41 maternal mortality observations in the Chelyabinsk region we have related 13 (32%) of them to the second group of death causes according to ICD-10. The average age of dead women was 29,5 years. In 77% of cases they were patients with burdened obstetric and gynecological anamnesis. The medical care was delivered to women in obstetric institutions of the 1st level. The revealed diseases we can divide upon the major classes as follows: infectious; defects of vascular system development; diseases of alimentary tract; systemic vasculitides. The death from indicated diseases was registered mainly in the 3rd trimester of pregnancy and postpartum period. In 8 cases we have noted the difference of clinical and pathoanatomical diagnoses of major disease. We have revealed 17 comorbide diseases, 6 complications. Herewith bi- and multicausal death genesis was registered in 92% of cases.Maternal mortality indirectly connected with obstetrical causes composes in the indicated subject 32%; all the cases of maternal mortality should be related to the category of the preventable ones; the activity development of the Regional perinatal center, adherence of routing of pregnant women, maternity patients and puerperae will contribute to the improvement of quality of health care delivering directed to maternal mortality prevention.