Ризики, ускладнення та перинатальні наслідки вагітності в контексті медичних і соціальних викликів війни: досвід України

The objective: to assess the impact of displacement caused by military actions on the course of pregnancy, the development of complications, and the condition of newborns.Materials and methods. The study included 76 pregnant women who were divided into two groups: I group – 38 patients with the status of internally displaced persons (IDPs), II group – 38 women who remained in their permanent place of residence. A retrospective analysis of the medical cards with evaluation of the pregnancy course, complications, labor characteristics, and outcomes, followed by statistical data processing, was conducted. The second phase of the study was an assessment of the newborn’s condition using the Apgar score and anthropometric measurements. The frequency of pathological conditions in newborns was also analyzed.Results. The average age of women was 29.70 ± 0.86 years. Analysis of pregnancy outcomes found that preterm birth was more frequent among women with IDP status (34.3%) compared to those who did not change their place of residence (28.9%). The mode of delivery analysis showed that vaginal births occurred in 42.2% of women in both groups, while cesarean section – in 57.8%. Among them the rate of emergency cesarean section was 70.5%, and it was more often performed in II group (58.06%), which may be due to the presence of chronic conditions, such as anemia or hypertensive disorders, which were more common in this cohort. In I group emergency cesarean section (41.93%) was performed because of the decompensation of acute complications caused by stress and infections. Planned cesarean sections were more common in the II group (61.6%) due to better medical supervision. Among pregnancy complications, infectious processes (38.9%) prevailed in the I group compared to the II group (11.1%). This difference is explained by the deterioration of sanitary and hygienic conditions and a decrease in immunity due to psycho-emotional stress and malnutrition. Anemia, on the other hand, was more in II group (47.2 vs 22.2% in I group), which indicates the insufficient effectiveness of its prevention among pregnant women even in stable conditions.Newborn condition was assessed using the Apgar score, where critical scores (1–4 points) were more frequent in I group (16.3%) compared to II group (14.7%). This is due to the negative impact of infections and stress on the pregnancy course among women with IDP status. Scores of 5–7 points were found in 32.7% of newborns in I group and 36% – in II group, which indicates a relatively equal impact of other obstetric risks associated with anemia or preeclampsia. A body weight of newborns ranged from 1,415 g (in cases of preterm birth with complications) to 4,700 g (in post-term pregnancy). In I group low birth weight of newborns (lt; 2,500 g) was more common, which was associated with placental insufficiency and intrauterine hypoxia caused by stress and limited access to quality medical care. In II group, newborns with high birth weight (gt; 4,000 g) more frequently experienced complications during delivery, such as shoulder dystocia and asphyxia.Perinatal mortality was recorded in 7 cases (9.2%), most often due to anemia, gestational hypertension, and preeclampsia, which led to placental blood flow disorders and fetal hypoxia.Conclusions. Premature births (34.3%), infectious complications (38.9%) and low birth weight were more common in the group of women with IDP status, which indicates the negative impact of stress, worsening living conditions and limited access to medical services. In women who did not change their place of residence, anemia (47.2%) and hypertensive disorders (36.6%) prevailed, which also affected the course of pregnancy, but under conditions of better medical management. The results of the study emphasize the critical role of social, medical, and psychological factors in the formation of perinatal risks, especially among women with IDP status, and highlight the need for enhanced monitoring, preventive measures, and support in wartime conditions.