Results of severe maternal morbidity surveillance and near-miss audit in Saint Petersburg according to the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS ACU&NEO) Register in 2021
The article presents the results of the surveillance of severe maternal morbidity (SMM) according to SMM surveillance regulations in the Russian Federation (RF). The study analyzed the SMM Register of the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS AKU&NEO) and the results of near-miss audit. The analysis included life-threatening maternal conditions without fatal outcome identified according to categories of organ dysfunction using the WHO diagnostic criteria (2011). The study aimed to identify strategies to reduce and prevent maternal mortality (MM) in Saint Petersburg. The authors analyzed the types of SMM registered in level II (51.0%) and level III (49.0%) maternal care providers (MCP) of Saint Petersburg. They also presented characteristics of near-miss cases, of which 12.5% and 83.3% occurred in level II and level III MCPs, respectively. Integral indicators of medical care quality in near-miss groups included near-miss rate, life-threatening condition rate, survival rate index, and mortality rate index. Obstetric pathology, blood pathology, and respiratory pathology were the leading causes of SMM in Saint Petersburg in 2021, which is comparable with the data of SMM registered in the Russian Federation in general. There were no cases of MM in the obstetric pathology group, which was the most frequently registered category of SMM (39.4% of the total number of SMM), including severe pre-eclampsia and eclampsia (83.1% of the group) and uterine rupture (9.6% of the group). The absence of MM in this category of SMM is associated with the implementation of effective and quality medical care in patients at high risk for obstetric and perinatal complications in Saint Petersburg in 2021. Blood pathology was the second most frequently registered category of SMM (36.8% of all SMM, 95.8% of the group); one case of MM was registered in a Level III MCP and one case outside the MCP before ambulance arrival. Both cases were associated with massive blood loss (more than 1000 ml). In 2021, during a pandemic of a novel coronavirus infection (COVID-19) in St. Petersburg, 41 cases of SMM associated with respiratory pathology (9.1% of total SMM) were reported. Of them 39 were identified as near-miss cases (respiratory dysfunction), which accounted for 54, 2% of the total number of near-miss cases with 20 deaths in level III MCPs. These deaths were due to severe or extremely severe bilateral viral or viral bacterial pneumonia complicated by acute respiratory distress syndrome or pulmonary embolism due to COVID-19 (O98. 5, U07.1). The main strategy to prevent and reduce the incidence of near-miss cases and MM based on improving the modern integral model of internal control of the quality of medical care in maternal care providers, near-miss audit, and the introduction into practice of both medical and organizational methodological, including telecommunications and other technologies aimed at improving professional competence.Bezhenar V.F., Sheshko E.L., Filippov O.S., Pryalukhin I.A., Nesterov I.M., Grinenko G.V., Shipulina U.A.
Conclusion: SMM surveillance and near-miss audit allows for a detailed assessment of the nature and quality of medical care to improve pregnancy outcomes.
Keywords
maternal near-miss surveillance and audit
severe maternal morbidity
SMM
woman who nearly died
maternal mortality
vertically integrated medical information system
VIMIS AKU&NEO
References
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Received 07.04.2022
Accepted 05.05.2022
About the Authors
Vitaly F. Bezhenar, Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Reproductology, Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia; Chief freelance specialist in Obstetrics and Gynecology of the Health Committee of the Government of Saint Petersburg,St. Petersburg, bez-vitaly@yandex.ru, https://orcid.org/0000-0002-7807-4929, Researcher ID: R-7055-2017.
Elena L. Sheshko, PhD, Associate Professor, Director of the Department of Child's Health Care, Maternity and Public Health Services of the Ministry of Health of Russia, Moscow, sheshkoel@minzdrav.gov.ru
Oleg S. Filippov, Dr. Med. Sci., Professor, Honored Doctor of the Russian Federation, Deputy Director for the Organization of Obstetric, Gynecological and Pediatric care, FNCC of Children and Adolescents of the FMBA of Russia; Professor at the Department of Reproductive Medicine and Surgery of the FDPO, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, filippovolsem@yandex.ru
Ivan A. Pryalukhin, PhD, Head of the Department of Organization of Project Activities, Academician V.I. Kulakov NMRC for AG&P, Ministry of Health of Russia, Moscow, i_prialukhin@oparina4.ru
Igor M. Nesterov, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Reproductology, Pavlov First Saint Petersburg State Medical University,
Ministry of Health of Russia, Saint Petersburg, ignester@yandex.ru, https://orcid.org/0000-0002-7558-7657
Galina V. Grinenko, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Neonatology, Pavlov First St. Petersburg State Medical University,
Ministry of Health of Russia; Chief Physician, City Perinatal Center No. 1, St. Petersburg, adkc@gpc1.ru
Ulyana A. Shipulina, Head of the Obstetric Diagnostic Advisory Center, City Perinatal Center No. 1, St. Petersburg, adkc@gpc1.ru
Corresponding author: Igor M. Nesterov, ignester@yandex.ru
Authors' contributions: Sheshko E.L., Bezhenar V.F., Filippov O.S. – conception and design of the study, manuscript drafting; Pryalukhin I.A., Grinenko G.V., Shipulina U.A. – data collection and analysis, statistical analysis; Nesterov I.M. – review of the relevant literature, manuscript drafting.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Bezhenar V.F., Sheshko E.L., Filippov O.S., Pryalukhin I.A., Nesterov I.M., Grinenko G.V., Shipulina U.A. Results of severe maternal morbidity surveillance and near-miss audit in Saint Petersburg according to the Vertically Integrated Medical Information System of Obstetrics and Gynecology and Neonatology (VIMIS ACU&NEO) Register in 2021.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 5: 118-127 (in Russian)
https://dx.doi.org/10.18565/aig.2022.5.118-127
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