Keywords
reproductive losses
fertility rates
screening genetic examinations
How to Cite
Abstract
The aim of the study was to determine the compliance of the existing medical care system in Ukraine for pregnant and married couples planning a pregnancy (its organizational and financial capabilities), the need to reduce the high level of reproductive losses.
Materials and methods. Methods of statistical and system analysis are used. The national programs of reproductive health, demographic data, data on morbidity (received from the national medical statistics for the period 2017–2018), reports of the national survey “Health Index of Ukraine” (2018), data on appeals for obstetric-gynecological, genetic care (in connection of reproductive losses, fertility) are analyzed. A comparison between the indicators of Ukraine and the Kharkiv region, as well as with other countries, according to the cost of the survey, requests for medical care for the examination of genetic and infectious diseases associated with reproductive losses, was made. The organization of outpatient care for pregnant and married couples who are planning a pregnancy has been analyzed in terms of availability and sources of payment for services.
Results. The number of Ukrainian women planning their first pregnancy aged 35 and over is increasing. Naturally, the number of genetic pathologies increases. Indicators of infectious pathology remain high. At the same time, women visit less gynecologists and family doctors, which is due to the high cost of the part of medical care that patients have to pay for themselves. Insufficiently developed genetic screening programs for genetic diseases. The professional contacts of physician of various specialties need to be improved. These facts negatively affect the level of reproductive losses, complicate their prevention.
Conclusions. To reduce reproductive losses, it is necessary to create a national disease monitoring center, increase the availability of obstetric-gynecological and genetic care for the population, increase coverage of genetic screening programs, and give birth to children at the optimal age of 20–34.
References
Alonso, S. G., de la Torre, D. I., Zapiraín, B.G. (2019). Predictive, Personalized, Preventive and Participatory (4P) Medicine Applied to Telemedicine and eHealth in the Literature. J Med Syst, 43(5), 140. DOI: 10.1007/s10916-019-1279-4.
On approval of the Concept of the National Program "Health 2020: Ukrainian Dimension": Cabinet of Ministers of Ukraine Decree No. 1164-p, October 31, 2011. Government portal: Unified web portal of the executive authorities of Ukraine. Retrieved from: https://www.kmu.gov.ua/npas/244717787 [In Ukrainian]
Bennett, L. R., de Kok, B. (2018). Reproductive Desires and Disappointments. Med Anthropol, 37(2), 91-100. PMID: 29257897. DOI: 10.1080/01459740.2017.1416609.
Bennett, L. R. (2018). Infertility, Adoption, and Family Formation in Indonesia. Med Anthropol, 37(2), 101-116. PMID: 29182369. DOI: 10.1080/01459740.2017.1407931.
Artini, P. G., Obino, M. E., Vergine, F., et al. (2018). Assisted reproductive technique in women of advanced fertility age. Minerva Ginecol, 70(6), 738-749. PMID: 29856189. DOI: 10.23736/S0026-4784.18.04247-8.
Marozio, L. Picardo, E., Filippini, C. et al. (2019). Maternal age over 40 years and pregnancy outcome: a hospital-based survey. J Matern Fetal Neonatal Med, 32(10), 1602-1608. PMID: 29216770. DOI: 10.1080/14767058.2017.1410793.
Demographic passport of the territory. State Statistics Service of Ukraine. Retrieved from: http://database.ukrcensus.gov.ua [In Ukrainian]
Permanent population of Ukraine 1990-2017. State Statistics Service of Ukraine. Retrieved from: http://www.ukrstat.gov.ua/operativ/operativ2007/ds/nas_rik/nas_u/nas_rik_u.xlsx [In Ukrainian]
Population of Kharkiv region 1990-2018. General Department of Statistics in Kharkiv region. URL: http://kh.ukrstat.gov.ua/naselennia-1995-2012 [In Ukrainian]
Timonina, M.B. (2019). Fertility, mortality, and average life expectancy tables for 2018. Statistical Collection. Kyiv: State Statistics Service of Ukraine, 2019. 66 p. Retrieved from: http://ukrstat.gov.ua/druk/publicat/kat_u/2019/zb/08/zb_tabl_nar_2018.pdf [In Ukrainian]
Demenina, N. K. Podolsky, V. V., Sorokin, A.V., et al. (2014). Features of pregnancy and childbirth in older women (literature review). Proceedings of the Association of Obstetricians-Gynecologists of Ukraine, 33/34(1/2), 107-110 [Citing the recommendations of the International Federation of Gynecology and Obstetrics (FIGO)] [In Russian]
Mirsaidova M.U. (2004). Features of the gestational process, childbirth, perinatal consequences, postpartum period and lactation in women of late reproductive age: Abstract of PhD diss. med. spec. "Obstetrics and Gynecology". Dushanbe. 19 p. [In Russian]
Hincz, P., Wojciechowska, E., Podciechowski, L., Kubiak, A., et al. (2006). Late maternity: the pregnancy and delivery in women after 35 years of age. Menopause Review / Przegląd Menopauzalny, 5(2), 80-84. Retrieved from: https://www.termedia.pl/Late-maternity-the-pregnancy-and-delivery-in-women-after-35-years-of-age,4,5940,0,1.html
Ustun, Y. Engin–Ustun, Y., Meydanil, M., et al. (2006). Maternal and neonatal outcomes in pregnancies at 35 and older age group. J Turkish German Gynecol Assoc, 6, 46-48.
Sauer, M. V. (2015). Reproduction at an advanced maternal age and maternal health. Fertil Steril, 103(5), 1136-1143. PMID: 25934599. DOI: 10.1016/j.fertnstert.2015.03.004.
Frederiksen, L. E., Ernst A., Brix N., et al. (2018) Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age. Obstet Gynecol, 131(3), 457-463. PMID: 29420406. DOI: 10.1097/AOG.0000000000002504.
Nilsson, S. F. Andersen, P. K., Strandberg-Larsen, K., et al. (2014). Risk factors for miscarriage from a prevention perspective: a nationwide follow-up study. BJOG, 121(11), 1375-1384. PMID: 24548778. DOI: 10.1111/1471-0528.12694.
Health Index. Ukraine-2018: Results of a nationwide survey. Compiled by Stepurko T.G. [et al.]. Kyiv, 2018. 172 p. Retrieved from: http://health-index.com.ua/zvit_index_2018_eng.pdf [In Ukrainian]
About Approval of the Procedure for Selection of Primary Care Medical Doctor and Forms of Declaration on Primary Care Doctor Selection: Ministry of Health Сare Order No. 503, March 19, 2018 (in force). Legislation of Ukraine, official site of the Verkhovna Rada. Retrieved from: https://zakon.rada.gov.ua/laws/show/z0347-18 [In Ukrainian]
Fundamentals of the Legislation of Ukraine on Health Care: Law of Ukraine No. 2801-XII, November 19, 1992, amended 1992-2019 (in force) (1993). Bulletin of the Verkhovna Rada of Ukraine, (4), Art. 19. [Cit.: Legislation of Ukraine, official site of the Verkhovna Rada] Retrieved from: https://zakon.rada.gov.ua/laws/show/2801-12 [In Ukrainian]
Jauniaux, E., Bhide, A. (2017). Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol, 217(1), 27-36. PMID: 28268196. DOI: 10.1016/j.ajog.2017.02.050.
Alieva, T.D.K. (2019). Medical and social services for prevention of congenital birth defects, in the aspect of the amine acid alteration in blood. Bull KhRIPHS, 87(1), 53-66. DOI: 10.5281/zenodo.3601660 [In Ukrainian]
Klimkin I.I. (2003). Cytogenetic assessment of mutagenic danger of urbanized territories of Ukraine: Abstract of PhD diss. biol. sc., spec. 03.00.15. O.M. Marzeyev Institute of Hygiene and Med. Ecol. AMS of Ukraine, Kiyiv. 20 p. [In Ukrainian]
Alieva, T.D.K. (2019). Principles of risk prevention of early reproductive losses in the context of oligonucleotide polymorphism of folate cycle genes. Bull KhRIPHS, 89(3), 4-23. DOI: 10.5281/zenodo.3582796 [In Ukrainian]
Kirihara, N., Kamitomo, M., Tabira, T., et al. (2018). Effect of probiotics on perinatal outcome in patients at high risk of preterm birth. J Obstet Gynaecol Res, 44(2), 241-247. PMID: 28994162. DOI: 10.1111/jog.13497.
Van Leeuwen, M., Vansenne, F., Korevaar, J. C., et al. (2013). Economic analysis of chromosome testing in couples with recurrent miscarriage to prevent handicapped offspring. Hum Reprod, 28(7), 1737-1742. PMID: 23613277. DOI: 10.1093/humrep/det067.
Dalton, V., Liang, K. A., Hutton, D. W., et al. (2015). Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss. Am J Obstet Gynecol, 212(2), 177, e1-6. PMID: 25174796 DOI: 10.1016/j.ajog.2014.08.031
Parmar, D., Leone, T., Coast, E., et al. (2017). Cost of abortions in Zambia: A comparison of safe abortion and post abortion care. Glob Public Health, 12(2), 236-249. PMID: 26708223. DOI: 10.1080/17441692.2015.1123747.
Banerjee S. Kumar K. R., Warvadekar J. et al. (2017). An exploration of the socio-economic profile of women and costs of receiving abortion services at public health facilities of Madhya Pradesh, India. BMC Health Serv Res, 17(1), art. No. 223. DOI: 10.1186/s12913-017-2159-6.
Galagan, V. A. (2004). Medical-genetic counseling in the system of genetic monitoring of the population: Abstract of diss. Doc. Med. Sc., spec. 03.00.15. O.M. Marzeyev Institute of hygiene and med. ecol. AMS of Ukraine, Kiyiv. 42 p. [In Ukrainian]
"Inter Collegas" is an open access journal: all articles are published in open access without an embargo period, under the terms of the CC BY-NC-SA (Creative Commons Attribution ‒ Noncommercial ‒ Share Alike) license; the content is available to all readers without registration from the moment of its publication. Electronic copies of the archive of journals are placed in the repositories of the KhNMU and V.I. Vernadsky National Library of Ukraine.