Features of the organization of perinatal care in Ukraine under the conditions of the state of martial

Анотація

The objective: the purpose of the study was to determine the specifics of the organization of perinatal care in Ukraine under martial law, based on a comparison of the leading indicators of health care facilities (HСРs) depending on the number of births per year, taking into account the type of facility in the hospital district.Materials and methods. The data of statistical reporting forms No. 21 and No. 20 of the Public Health Center of the Ministry of Health of Ukraine were analyzed. For comparison, the data of statistical forms for 2019, as the last year before the СOVID-19 pandemic and the war in Ukraine, and 2023, as a full year of martial law caused by the war with rf, were selected. The comparison of activity indicators was carried out separately for three groups of health centers (Ivano-Frankivsk, Zhytomyr, Chernihiv regions) depending on the number of labors per year, that is: up to 300 labors (group 1, n = 22), 300–1500 labors (group 2, n = 23), more than 1500 labors (group 3, n = 10).Mathematical calculations were performed using the «MedCalc® Statistical Software version 22.009» package.Results. The analysis of the obtained results indicates a significant decrease in the average number of labors in health centers with more than 1,500 labors per year (p<0.05) during the period of martial law in Ukraine caused by the war with rf. During this period, the number of HCPs in the group increased to 300 deliveries, among which the vast majority are general HCPs of the hospital district. In this group, the number of physiological labors significantly decreased (from 76.3 ± 8.9 in 2019 to 67.8 ± 7.0 in 2023; (p = 0.023). In the groups of health centers with the number of labors up to 300 and 300–1500 per year, which belong to cluster health centers, the proportion of caesarean sections increased significantly (from 16.8 (12.4–24.4)% to 26.5 (23.7–29.0)% and from 19.2 (17.2–20.6)% to 25.3 (24.1–26.1)%, respectively p < 0.001). Surgical delivery per 1 labor (from 1.72 ± 0.62 to 1.25 ± 0.27; p < 0.05) against the background of an increase in the proportion of cesarean sections. In the groups of health centers with the number of deliveries of 300–1500 and more than 1500 per year, the number of deliveries per 1 obstetrician decreased significantly (from 87.2 ± 21.3 to 63.6 ± 21.0 and from 114.1 ± 22.1 to 80.3 ± 18.1, respectively; p < 0.05).Conclusions. During the period of martial law in Ukraine, the activity indicators of health centers that provide perinatal care changed depending on the number of labors: the number of labors per year and the workload per 1 obstetrician-gynecologist decreased, the share of health care centers with the number of births up to 300 per year and the share of cesarean deliveries increased in the total number of births. The identified negative trends require taking measures to improve the availability and quality of medical care for pregnant women, women in labor and women in labor in the hospital district and the effective use of human resources in the conditions of martial law.

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