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Maternal mortality in Republic of Moldova: medico-social, demographic, management aspects and ways of decreasing


Author: Dondiuc Iurie
Degree:doctor habilitat of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Year:2019
Scientific consultant: Olga Cerneţchi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 5 February, 2019
Approved by NCAA on the 15 March, 2019

Abstract

Adobe PDF document – 1.23 Mb / in romanian

Thesis

CZU [618.7-089.168.86:314.1+614.1](478)

Adobe PDF document 4.38 Mb / in romanian
259 pages

Keywords

maternal mortality, maternal health, maternal near miss, management of perinatal care, the structure of perinatal medical assistance, obstetrics and gynecology specialists, demographic prognosis

Summary

Structure of the thesis: presented in 2 volumes (main and complementary part). The main part contains: introduction, 6 chapters, general conclusions, practical recommendations, a bibliography of 347 sources, 228 pages of main text with 43 tables and 88 figures. The complementary part contains 16 annexes. The author published 56 scientific works related to the research subject. Keywords: maternal mortality, maternal health, maternal near miss, management of perinatal care, the structure of perinatal medical assistance, obstetrics and gynecology specialists, demographic prognosis. Field of research: Obstetrics and Gynecology.

The aim of the study: Clinical-epidemiological, managerial and demographic assessment of the maternal mortality phenomenon in the Republic of Moldova, with scientific argumentation of existing limitations in reducing maternal deaths and development of complex recommendations for the diminution of this indicator.

Objectives of research: Analyze the maternal mortality and determine the evolution, tendencies, structure and the main causes of maternal death, its medical, social and management factors; Assess the quality of perinatal medical care in severe obstetric cases, considered as proximity to maternal death; Identify the role of human factor in the delivery of medical services, its impact on maternal health and perspectives of perinatal service development; Study the demographic trends and the main factors of population’s natural movement, in order to identify the necessary actions to ensure a safe maternity; Analyze the evolution of births’ rate and the efficiency of maternity placements within the current medical system and demographic perspectives, for the optimization of the obstetrical service and development of an effective model of perinatal medical care for the Republic of Moldova; Scientific argumentation of the existing limitations in reducing the maternal mortality, thus proposing practical recommendations to decrease this indicator. Research novelty and originality consists in the multilateral approach of the maternal mortality problem – for the first time in the Republic of Moldova there was performed a complex study of maternal mortality according to time, space and environment aspects, focused on the improvement of existing situation and the building of a new development strategy of the obstetrical service, considering actual conditions and demographic perspective. The demographic prognosis also represents a new aspect that made possible the development of presumptive scenarios of population’s evolution according to age and gender structure. The research presents an assessment made for the first time in the country, of the obstetrics and gynecology specialists’ capacities and actual situation, laying out the perspectives in ensuring the population with these specialists in the future.

The major scientific problem solved in this study is the evaluation of the social, medical, demographic and managerial factors’ impact on the maternal mortality in Republic of Moldova, which enables the identification of existing limitations in providing quality medical services and the acknowledgment of the necessary measures to reduce the maternal deaths, considering the low natality level, insufficient medical specialists, the projected demographic changes and their revaluation in development strategies and policies of the mother and child’s healthcare service.

Theoretical significancereveals in the presentation of the maternal mortality phenomena in a wide and multilateral approach, which describes medical, social, demographic and managerial aspects of maternal deaths and acknowledges the interdependence of these factors and their impact on maternal health.

Applicative value of the study: the research presents the analysis of maternal death cases, with the description of annual and five years dynamic of maternal mortality indicators, the cause structure of maternal mortality and its evolution. Also, the study offers a characteristic of the major demographic phenomena with the detailed picture of the demographic evolution in the Republic of Moldova, proposing a model of demographic prognosis of natality and population structure for the next decades.

Implementation of the scientific results. The results of the research were used in preparation of the directive documents of the Ministry of Health, in the activity of sanitary-medical institutions of national, municipal and district levels, in the development of perinatology national guidelines, in didactic and methodology references, clinical protocols and as a didactic material in training the students and residents, family doctors, resident doctors and obstetrics and gynecology specialists at SUMP „Nicolae Testemitanu”.