A few years ago, a typical "complex case" in obstetrics meant one comorbid condition. Today, doctors increasingly see three or four diagnoses at once in a patient's medical record. And this is no coincidence.
What has changed
Obstetrician-gynecologist Vladyslav Yavir noted in a comment to UNN a trend that clinicians observe practically everywhere: women become pregnant with already existing chronic diseases, and pregnancy exacerbates them or provokes new ones.
"We now more often encounter not just one disease, but a combination of diseases, a combination of pathologies, such as, for example, anemia, gestational diabetes mellitus, preeclampsia and chronic hypertension, arterial hypertension".
Vladyslav Yavir, obstetrician-gynecologist
Each of these pathologies individually is a manageable condition. In combination, they reinforce each other: anemia reduces adaptive reserve, hypertension against the background of preeclampsia increases the risk of eclampsia, uncompensated diabetes damages placental vessels. It is precisely this combination, not each diagnosis on its own, that is the main source of complications.
Numbers behind the doctor's words
- Gestational diabetes mellitus develops in 5–10% of pregnant women — mostly in the second trimester, when placental hormones increase insulin resistance.
- Iron deficiency anemia remains the most common pathology of pregnancy in Ukraine; if it exists already in the first trimester, it almost always means the disease was present before conception.
- According to UNFPA, the maternal mortality rate in Ukraine rose from 18.9 to 25.9 cases per 100,000 live births between 2023 and 2024 — an increase of about 37%. Among the causes are complications associated precisely with insufficient or untimely monitoring.
A separate dimension: women from frontline territories
Yavir separately emphasizes the problem of inadequately examined patients. This concerns first and foremost women from frontline and occupied regions — those who either have no physical access to monitoring or have postponed it due to evacuation, stress, or lack of documents.
UNFPA in 2024 supported perinatal centers near the front line, including the Zaporizhzhia Regional Center, where medics deliver babies under constant shelling. But infrastructure support does not solve the problem of women who simply never made it to the maternity hospital — neither for examination nor for pregnancy management.
The danger here lies not only in failing to detect pathology in time. An unexamined woman with preeclampsia or uncompensated diabetes arrives at the hospital already in a condition where the window for planned treatment has closed — only emergency care remains.
What really helps
Prevention in this context is not abstract "healthy lifestyle and vitamins." Doctors speak of concrete measures:
- Preconception preparation — examination before pregnancy to identify and compensate for chronic conditions before they become obstetric complications.
- Early registration — before 12 weeks, when basic screening allows for a realistic picture of risks.
- Glucose tolerance test at 24–28 weeks — the only reliable way to detect gestational diabetes, since it often passes asymptomatically.
- Blood pressure monitoring and general blood tests at each visit — to avoid missing the onset of anemia or hypertension.
For women who cannot physically visit a doctor, UNFPA and the Ukrainian medical community are developing telemedicine consultations: remote consultations do not replace ultrasound, but allow timely assessment of complaints and referral to where equipment is available.
The key question is not medical but logistical: if a woman from a frontline zone physically cannot reach a specialist in the first trimester — what specific mechanism of mobile or outreach medical brigades has the Ministry of Health introduced in her district and does it actually work?
