A French audit of maternity unit protocols for immediate postpartum hemorrhage: A cross-sectional study (HERA)

Vendittelli, Françoise; Barasinski, Chloé; Legrand, Anne; Costa-Correia, Caroline da; Crenn‐Hébert, Catherine; Rivière, Olivier; Dreyfus, Michel; Lémery, D.

doi:10.1016/j.jogoh.2020.101934

Cited by 3 publications

(7 citation statements)

References 25 publications

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“…In a first step, an observational multicenter audit was conducted to assess the quality of the written protocols of French maternity units for the prevention and management of immediate PPH [ 25 ]. In September 2010, we asked 300 maternity units to send the study team a copy of the protocol used in their maternity unit (i.e., specific to their maternity unit or, at minimum, their perinatal network) for PPH prevention and management (by email, no later than June 2011).…”

Section: Methodsmentioning

confidence: 99%

“…Two email reminders were sent during this period. We built an audit screening form to assess each unit’s protocol based on 22 criteria highly recommended by the French College of Gynecologists and Obstetricians (CNGOF): 15 for vaginal deliveries ( Table S1 ) and 7 applicable only to caesarean deliveries [ 25 ]. These ranged from a clear definition of PPH to the steps for its prevention and management [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…In the third step, we analyzed only the 177 maternity units that had participated in both components of the HERA study (PPH incidence and protocol audit), described in steps one and two [ 6 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

“…One important way to optimize PPH prevention and care may be the translation of evidence-based guidelines into comprehensive maternity unit protocols. Only a few studies have performed audits of the quality of protocols, and they have underlined their suboptimal quality [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

et al. 2022

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Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

et al. 2022

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“…Severe maternal and neonatal morbidities should be considered as quality markers, or more precisely, indicators of missed opportunities for optimal prevention and/or the management of complications during pregnancy, childbirth, and neonatal care; they are thus important keys for preventing severe maternal or neonatal morbidity [ 24 , 25 ]. To think that having national guidelines is enough to improve practices is wrong [ 25 , 26 ]. We need good methodological and updated national guidelines and adequate local protocols adapted to the local organization to reduce substandard care [ 25 , 26 ].…”

Section: Then What Can We Do?mentioning

confidence: 99%

Safety and Quality in Maternal and Neonatal Care: Any Progress since Ignaz Semmelweis?

Vendittelli

2022

Healthcare

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Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study)

et al. 2023

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Changes between pre- and postpartum hemoglobin might be useful for optimizing the postpartum diagnosis of postpartum hemorrhage (PPH), defined as a blood loss exceeding 500 mL. This study’s principal objective was to estimate the mean change in hemoglobin (between pre/post-delivery hemoglobin) among women with vaginal deliveries and PPH. The secondary objectives were to analyze: hemoglobin changes according to blood volume loss, the appropriateness of standard thresholds for assessing hemoglobin loss, and the intrinsic and extrinsic performances of these threshold values for identifying PPH. French maternity units (n = 182) participated in the prospective HERA cohort study. Women with a vaginal delivery at or after a gestation of 22 weeks with a PPH (n = 2964) were eligible. The principal outcome was hemoglobin loss in g/L. The mean hemoglobin change was 30 ± 14 g/L among women with a PPH. Overall, hemoglobin decreased by at least 10% in 90.4% of women with PPH. Decreases ≥ 20 g/L and ≥40 g/L were found, respectively, in 73.9% and 23.7% of cases. Sensitivity and specificity values for identifying PPH were always <65%, the positive predictive values were between 35% and 94%, and the negative predictive values were between 14% and 84%. Hemoglobin decrease from before to after delivery should not be used as a PPH diagnostic screening test for PPH diagnosis for all vaginal deliveries.

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A French audit of maternity unit protocols for immediate postpartum hemorrhage: A cross-sectional study (HERA)

Cited by 3 publications

References 25 publications

Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study

Safety and Quality in Maternal and Neonatal Care: Any Progress since Ignaz Semmelweis?

Change in Hemoglobin Was Not a Reliable Diagnostic Screening Test for Postpartum Hemorrhage: A French Prospective Multicenter Cohort Study (HERA Study)

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