Maternity Care in Russia: Issues, Achievements, and Potential.

In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ≥ 500 g at ≥ 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10 000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44 000, providing a ratio of 5.7 specialists per 10 000 women. The total number of midwives is 62 000, providing a ratio of 8.1 midwives per 10 000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection.

Dans le cadre de cette analyse, nous fournissons des faits de base au sujet des soins de maternité offerts par le système de santé en Russie. Nous y offrons un bref survol de certains aspects clés : situation démographique, comportements génésiques, cadre réglementaire de l'offre de soins de santé aux femmes et aux enfants, mortalité maternelle et périnatale, et disponibilité du personnel médical. En 2012, la Russie a commencé à enregistrer les naissances en fonction des recommandations de l'OMS (naissances en présence d'un poids ≥ 500 g à ≥ 22 semaines de gestation). La mise en œuvre de ce nouveau système d'enregistrement a accru l'exhaustivité et la qualité des renseignements recueillis, en plus d'élargir les possibilités en ce qui concerne la future tenue d'évaluations comparatives internationales. Un système de soins médicaux spécialisés à trois paliers offerts pendant la grossesse, l'accouchement et la période postpartum a été mis en œuvre en Russie pour les femmes et les nouveau-nés. En 2014, le système comptait 1 942 hôpitaux de maternité d'état (publics) offrant 20 lits en obstétrique par 10 000 femmes âgées de 15 à 49 ans. Plus de 100 centres périnataux (niveau III) sont actuellement en fonction dans le pays; l'ouverture de 32 nouveaux centres périnataux est prévue pour 2016. En Russie, le nombre total d'obstétriciens-gynécologues s'élève à environ 44 000, soit 5,7 spécialistes par 10 000 femmes. Le nombre total de sages-femmes s'élève à 62 000, soit 8,1 sages-femmes par 10 000 femmes. En accroissant l'accessibilité et la qualité du système de soins de maternité au cours des dernières années, nous avons réussi à en optimiser le fonctionnement. Nous y sommes parvenus grâce à l'évolution qualitative et quantitative de la formation des néonatologistes, à l'élaboration de technologies des soins intensifs et à la mise sur pied de soins intensifs néonataux, au renforcement des capacités en matière de counseling et de services médico-génétiques, au diagnostic prénatal et à la standardisation des soins de santé grâce à la collecte de données.

A prospective, open-label, non-comparative study of palivizumab prophylaxis in children at high risk of serious respiratory syncytial virus disease in the Russian Federation.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTIs) in children globally. Predisposing conditions for the development of serious RSV disease include preterm infants and those with cardiopulmonary illness, including congenital heart disease (CHD) and bronchopulmonary dysplasia (BPD). No vaccine is currently approved for the prevention of RSV infection. It is recommended that children at high risk be prophylactically administered palivizumab, a monoclonal antibody that has been shown in a number of clinical studies to reduce hospitalization rates due to serious RSV infection. The objective of the current study was to determine the safety and effectiveness of palivizumab in preventing serious RSV disease in high-risk children in the Russian Federation. Children at high risk of serious RSV disease (ie, born at ≤ 35 wk gestational age and ≤ 6 mo of age, and/or aged ≤ 24 mo with BPD or hemodynamically significant CHD) were enrolled. Subjects were to receive 3 to 5 monthly injections of palivizumab 15 mg/kg (depending on the month of the initial injection) over the RSV season. The primary endpoint was RSV-related hospitalizations. Adverse events (AEs) were reported through 100 days following the final injection. RESULTS: One hundred subjects received ≥ 1 injection of palivizumab; 94 completed their dosing schedule. There were no RSV hospitalizations or deaths. Six of 7 subjects hospitalized for respiratory/cardiac conditions had an RSV test, which was negative in all cases. Three non-serious AEs (acute intermittent rhinitis and rhinitis, 1 subject; atopic dermatitis, 1 subject) were considered possibly related to palivizumab. All other AEs were mild or moderate and considered not related/probably not related to palivizumab. CONCLUSION: Palivizumab was generally well tolerated and effectively prevented serious RSV infection in a mixed population of high-risk children in the Russian Federation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01006629.