LEADING FACTORS FOR DEATH DURING LABOR IN BULGARIA

Abstract

During the period 2010-2020, it was found that in Bulgaria the mortality rate among women in labor is medium to high, compared to the same in other countries in Europe. Aim: to identify the direct and indirect causes of maternal mortality in Bulgaria and to determine which of them are controllable and how they can be affected. Methodology: Based on the statistical data from the study on maternal mortality in Bulgaria, for the ten-year period the Pareto principle has been applied to identify the leading conditions - the cause of mortality. A retrospective method was used, based on case histories and autopsy case reports. Results: Twenty percent of direct causes such as amniotic embolism, preeclampsia, eclampsia, postpartum hemorrhage and sepsis form 80% of all direct causes of maternal mortality in Bulgaria. Twenty-four percent are indirect causes of cardiovascular disease, pneumonia, which form seventy-six percent of all indirect causes of maternal mortality in Bulgaria. Discussion: A total of fifty-two cases provided by all hospitals in Bulgaria for the given period were studied. Between 76% - 86% of mortality in women giving birth in Bulgaria for the study period are due to amniotic embolism, preeclampsia, eclampsia, sepsis and postpartum hemorrhage. Of these, conditions such as preeclampsia, eclampsia and sepsis are controlled by methods of monitoring and prevention of pregnancy. Of the concomitant conditions, cardiovascular disease is a controllable factor through prevention and treatment.

By managing conditions such as amniotic embolism, preeclampsia, eclampsia and haemorrhage in women in labor, mortality will be reduced by 50% or 40% and up to 1/3 of cases. The "points" in the health system where obstetric / direct causes of maternal mortality arise remain hidden. Most of them are university and district hospitals. This probably refers to patients transferred from other levels of the system, as well as gaps in the monitoring of pregnancy in outpatient care. Conclusions: There is an imbalance from the standard accepted as a ratio of the Pareto principle, which is a natural phenomenon. The Pareto principle applied to the study of maternal mortality shows the most important conditions and factors, and thus where to direct the forces of the system to control them. There is a need for in-depth and systematic study to monitor pregnancy and related conditions and comorbidities in outpatient care and hospitals.