Summary. In April 2012, Russia introduced new birth criteria - birth weight 500 grams and 22 weeks of gestation. According to this criteria termination of pregnancy at 22-27 weeks of gestation that used to be termed as "late abortion" before 2011 should be considered and registered as extremely premature birth starting April 2012. This reform has been accompanied by reorganization of outcomes of registered pregnancies - births and abortions as well as the number of births and deaths by body weight.

Objective of the study was to determine changes in the pregnancy outcomes structure and perinatal situation in the context of new birth criteria.

Methods and information sources included comparison of official statistics from Federal Statistic Monitoring forms #13, #14 and #32 for 2011-2012.

Results and conclusions include that the number of pregnancies terminated at 22-27 weeks of gestation in 2012 decreased by 42% from 16336 in 2011 to 9639. The share of terminated pregnancies at 22-27 weeks of gestation out of all registered pregnancies (births and abortions) decreased from 0.60% to 0.34%.

Share of birth weights 500-999 grams ("fetus" according to the previous terminology when termination of pregnancy at 22-27 weeks of gestation was considered as an abortion) decreased from 0.88% out of the number of live and still births in 2011 to 0.53% in 2012. At the same time the share of "extremely low birth weight" 1000-1499 grams increased by 20.5% from 0.64% to 0.73% out of the number of all births confirming underreporting of this weight category in the previous years; this weight category was pinged in the group of birth weight under 1000 grams that was not counted by the infant and perinatal mortality statistics.

Inverse change in 2012 in the share of birth weight 1000-1499 grams (increase) and birth weight under 1000 grams (decrease) reflects a fundamental change in the approach towards registration of births, deaths and still births with birth weight 500-999 grams, that are now registered on the same basis as other birth weight  categories under 1000 grams.

In 2012 perinatal mortality rate in maternity obstetric facilities increased because of birth weights under 1000 grams and added up to 9.75 per 1000 live and still births (compared to 6.72‰ in 2011). However, if we compare similar indicators for birth weights "1000 grams and up" (not including birth weights under 1000 grams) we will see increase in still births in 2012 (from 4.62 in 2011 to 4,79‰) and perinatal mortality (from 6.72 to 6,82‰) that may suggest a more reliable registration of deaths under the new birth criteria. 

Drastic changes in such a static biological parameter as gestational structure of pregnancy termination occurring within a year are conditioned by market factors - review of terms of terminated pregnancy according to new criteria of births and abortions.

Keywords: birth; preterm birth; abortion; late abortion; birth criteria; pregnancy outcome; extremely low birth weight neonates; perinatal mortality; still birth.

References

1. Andreev EM, Kvasha EA. A new assessment of infant mortality: preliminary results. Äåìîñêîï.ðó [Internet] 2013 Feb 17; (541-542). [cited 2013 May 22). Available from: http://demoscope.ru/weekly/2013/0541/analit05.php (in Russian).
2. Baybarina EN. The basic activities of the Ministry of Health of the RF in the field of child healthcare. Zamestitel' glavnogo vracha 2013;(5): 11-16. (in Russian).
3. Baranov AA, Ignat'eva RK. The problem of underreporting of perinatal loses. In: Baranov AA, Al'bitskiy VYu. Mortality of children population of Russia. Series "Sotsial'naya pediatriya". Vol 1. Moscow: Littera; 2007. P. 45-59. (in Russian).
4. Intensive therapy and the methods of nursing the children with extremely low and very low birth weight: the Methodical Letter of MoH&SD of the RF ¹15-0/10/2-11336 of 2011 December 16. [Online] Available from: URL: http://www.minzdravsoc.ru/docs/mzsr/letters/213 (Cited 2013 May 22) (in Russian).
5. On amendments to Supplements ¹1 è ¹3 to the Regulation of the Ministry of Health and Social Development of the Russian Federation of 2011 December 27 N 1687í "On medical criteria of birth, the birth registration form  and the procedure for its issuance", the Regulation of the Ministry of Health of the RF of 2013 January 16 N 7í". [Internet] 2013 [cited 2013 May 22]. Available from: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=144235 (in Russian).
6. On the issues of organization of perinatal centers: the Regulation of the Ministry of Health and Social Development of the Russian Federation of 2004 December 9 ¹308. [Internet] 2004 [cited 2013 May 22]. Available from: http://www.bestpravo.ru/federalnoje/ew-normy/x1w.htm (in Russian).
7. On medical criteria of birth, the birth registration form and the procedure for its issuance": the Order of the Ministry of Health and Social Development of the Russian Federation ¹1687í of 2011 December 27 [Internet]. 2012 [cited 2013 May 22]. Available from: http://www.minzdravsoc.ru/docs/mzsr/orders/1245 (in Russian).
8. On transition to the criteria of live birth and dead birth recommended by WHO: the Regulation of the Ministry of Health and Social Development of the Russian Federation of 1992 December 4 ¹318/190. [Internet] 1992 [cited 2013 May 22]. Available from: http://www.medicus.ru/handbook/legal/document26380.phtml (in Russian).
9. On organization of maternity hospitals (departments): the Regulation of the Ministry of Health and Social Development of the Russian Federation of 2007 September 24 ¹621. [Internet] 2007 [cited 2013 May 22]. Available from: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=73310 (in Russian).
10. On approving the Rules for delivering obstetric and gynecological care: the Regulations of the Ministry of Health and Social Development of the Russian Federation of 2009 October 2. ¹808í. [Internet]. 2009 [cited 2013 May 22]. Available from: http://www.minzdravsoc.ru/docs/mzsr/family/8) (in Russian).
11. On approving the Rules of delivering medical care in "neonatology": the Regulation of the Ministry of Health of the RF of 2012 November 15 N 921í. [Internet] 2012 [cited 2013 May 22]. Available from: http://www.referent.ru/1/208481 (in Russian).
12. On approving the Rules for delivering medical care in "Obstetrics and Gynecology" (except for the use of assisted reproductive technologies): the Order of the Ministry of Health and Social Development of the Russian Federation of 2012 November 12 ¹ 572í. [Internet]. 2012 [cited 2013 May 22]. Available from: http://www.rosminzdrav.ru/docs/mzsr/orders/1342 (in Russian).
13. On approving the Rules for delivering neonatal medical care: the Regulation of the Ministry of Health and Social Development of the Russian Federation of 2010 June 01 N 409í. [Internet] 2010 [cited 2013 May 22]. Available from: URL: http://mzsrrf.consultant.ru/page.aspx?20467 (in Russian).
14. Primary and emergency care to newborns: the Methodical Letter of the Ministry of Health and Social Development of the Russian Federation of 2010 April 21 N 15-4/10/2-3204. [Internet]. 2010 [cited 2013 May 22]. Available from: http://www.bestpravo.ru/federalnoje/bz-pravila/g5a.htm (in Russian).
15. Radzinskiy VE. Unsolved problems of reproductive medicine. Report. "Reproductive potential of Russia: versions and controversies". The 5-th All-Russian Seminar, Sochi, 2012 September. [Internet]. Proceedings. 2012; p. 4-6. 2012 [cited 2013 May 22]. Available from: http://praesens.ru/assets/files/post_reliz/Postreliz_%20Sochi_2012_light.pdf (in Russian).
16. Starodubov VI, Sukhanova LP. Reproductive problems of demographic development of Russia. Moscow: ID Menedzher zdravookhraneniya; 2012. 320 p. (in Russian).
17. Starodubov VI, Sukhanova LP, Sychenkov YuG. Reproductive losses as a health and social problem of demographic development of Russia. Sotsial'nye aspekty zdorov'ya naseleniya [Online Scientific Journal] 2011 [cited 2013 May 22]; 22(6). Available from: http://vestnik.mednet.ru/content/view/367/27/lang,ru/ (in Russian).
18. Sukhanova LP, BushmelevaNN, Sorokina ZKh. Infant mortality in Russia in view of reliability of its registration. Sotsial'nye aspekty zdorov'ya naseleniya [Online Scientific Journal] 2012 [cited 2013 May 22]; 28(6). Available from: URL: http://vestnik.mednet.ru/content/view/441/27/lang,ru/ (in Russian).
19. SychenkovYu.G., Sukhanova L.P. Problems of organization of neonatal emergency care in maternity hospitals. Sotsial'nye aspekty zdorov'ya naseleniya [Online Scientific Journal] 2012 [cited 2013 May 22]; 25(3). Available from: http://vestnik.mednet.ru/content/view/409/30/lang,ru/ (in Russian).

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