FEATURES OF PERINATAL CARE IN A LEVEL III MATERNITY HOSPITAL:CURRENT REALITIES

In the Poltava region, as in the rest of Ukraine, the ongoing demographic crisis—exacerbated by the full-scale war initiated by the russian federation and the migration of the female population—has resulted in a decline in overall birth rates and an increase in the proportion of cesarean deliveries. Purpose. To identify the key obstetric and neonatal challenges encountered by a Level III maternity hospital in providing perinatal care under conditions of martial law. Methods and Material. Annual reports from obstetric hospitals in the Poltava region concerning the provision of medical care to pregnant, parturient, and puerperal women were analyzed (Form No. 21, approved by Order No. 378 of the Ministry of Health of Ukraine dated 10.07.2007), along with reports on the medical care of parturient/puerperal women, neonates, and infants in their first year of life (Form No. 21-a, approved by Order No. 24 of the Ministry of Health of Ukraine dated 24.01.2008). These data were obtained from the Department of Economic and Medical Statistics, Analytics, Monitoring and Evaluation of the Municipal Enterprise “Poltava Regional Center for Public Health” under the Poltava Region Council for the years 2020–2024. Additionally, annual reports from the obstetric hospital, pregnancy pathology and extragenital pathology units, as well as the anesthesiology and neonatal intensive care units (including a mobile neonatal team) at the Perinatal Center (PC) of the Municipal Enterprise “Poltava Regional Clinical Hospital named after M.V. Sklifosovsky” were examined. . A total of 217 pregnancy and childbirth histories from patients who delivered at the same institution in 2024 were also analyzed. Results and Discussion. The analysis of the obstetric unit at the Perinatal Center of the Municipal Enterprise “Poltava Regional Clinical Hospital named after M.V. Sklifosovsky” demonstrated a consistent annual increase in the rate of preterm births since the onset of martial law. The incidence of childbirth complicated by combined and severe preeclampsia has risen by approximately 1.5 times compared to 2020, while pregnancies affected by gestational diabetes mellitus have become more than three times as frequent relative to the pre-war period. During wartime, patients without somatic or obstetric pathologies—yet with a uterine scar from a prior cesarean section or breech presentation—were more likely to adhere to physicians’ recommendations to avoid surgical delivery when deemed safe. The findings also underscore concerns about the cesarean section rate at Level I perinatal care facilities, which exceeds the recommended threshold by more than fourfold. Additionally, the possible underestimation of neonatal resuscitation risk factors at Level I and II perinatal facilities raises concerns regarding the appropriateness of delivery site selection for high-risk pregnancies. Conclusions. Since the onset of full-scale war in the Poltava region, there has been a marked increase in cesarean delivery rates, preterm births, and pregnancy complications such as severe and combined preeclampsia and gestational diabetes mellitus. The timely referral and transport of pregnant women at elevated risk of maternal and neonatal complications to Level III perinatal care facilities—specifically the Perinatal Center of the Municipal Enterprise “Poltava Regional Clinical Hospital named after M.V. Sklifosovsky”—is essential for ensuring the highest standard of perinatal care and safety.