Ten Years of Confidential Inquiries Into Maternal Deaths in France, 1998–2007

Saucedo, M.; Deneux‐Tharaux, Catherine; Bouvier‐Colle, Marie‐Hélène

doi:10.1097/aog.0b013e31829fc38c

Cited by 122 publications

(49 citation statements)

References 23 publications

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“…In France, PPH was the leading cause of death, responsible for 18 % of maternal deaths in the decade from 1998 to 2007 [3]. Hemorrhage-related events are among the most preventable causes of maternal death.…”

Section: Introductionmentioning

confidence: 99%

Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study)

Vendittelli

Barasinski

Pereira

et al. 2016

BMC Pregnancy Childbirth

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BackgroundMost estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies.Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management.MethodsThis prospective observational study took place in French maternity wards. Women who gave birth at a term ≥ 22 weeks were eligible for the study. 182 maternity units participated in a study with prospective data collection from 1 February, 2011, to 31 July, 2011. The main outcome measure was PPH incidence.ResultsPPH incidence after vaginal delivery was 3.36 % [95 % CI: 3.25–3.47 %] and after cesareans 2.83 % [95 % CI: 2.63–3.04 %]. The incidence of severe PPH after vaginal delivery was 1.11 % [95 % CI: 1.05–1.18 %] and after cesareans 1.00 % [95 % CI: 0.88–1.13 %]. This incidence rate varied according to maternity unit characteristics. The principal cause of PPH for both modes of delivery was uterine atony (57.7 % for vaginal births and 66.3 % for cesareans). Vascular embolization was more frequent among women with cesareans (10.0 vs. 2.9 %), who also required transfusions more often (44.4 vs 12.7 %).ConclusionsThe incidence of PPH was lower than the rate expected from the literature. Effective treatment of uterine atony and optimizing the identification of blood loss remain important priorities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1008-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study)

Vendittelli

Barasinski

Pereira

et al. 2016

BMC Pregnancy Childbirth

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“…Despite these changes, haemorrhage remains a major cause of maternal mortality . Maternal deaths from primary postpartum haemorrhage (PPH) in France are two times higher than in the Netherlands and four times higher than in the UK …”

Section: Introductionmentioning

confidence: 99%

Invasive therapies for primary postpartum haemorrhage: a population‐based study in France

Kayem

Dupont

Bouvier-Colle

et al. 2015

BJOG

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Objective To describe the characteristics, management, and outcomes of women undergoing invasive therapies for primary postpartum haemorrhage (PPH).Design A population-based observational study.Setting All 106 maternity units of six French regions. Methods Prospective identification of women with PPH managed with invasive therapies, including uterine suture, pelvic vessel ligation, arterial embolisation, and hysterectomy.Main outcome measures Rate of use and failure rate of invasive therapies, with 95% confidence intervals (95% CIs).Results An invasive therapy was used in 296 of 6660 women with PPH (4.4%, 95% CI 4.0-5.0), and in 0.2% of deliveries (95% CI 0.18-0.23). A hysterectomy was performed in 72/6660 women with PPH (1.1%, 95% CI 0.8-1.4%), and in 0.05% of deliveries (95% CI 0.04-0.06). A conservative invasive therapy was used in 262 women, including 183 (70%) who underwent arterial embolisation and 79 (30%) who had conservative surgery as the first-line therapy. Embolisation was more frequently used after vaginal than caesarean delivery, and when arterial embolisation was available on site. The failure rate of conservative invasive therapies was 41/262 (15.6%, 95% CI 11.5-20.6) overall, and was higher after surgical than after embolisation procedures, in particular for vaginal deliveries.Conclusions Both maternal mortality as a result of obstetric haemorrhage and the rate of invasive therapies used for PPH are high in France. These findings suggest flaws in the initial management of PPH and/or the inadequate use of invasive procedures.Keywords Embolisation, hysterectomy, maternal mortality, pelvic vessel ligation, postpartum haemorrhage, uterine compression sutures.Tweetable abstract Maternal mortality as a result of haemorrhage and the rate of invasive therapies used for PPH are high in France.

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“…An inaccurate estimation of blood loss could result in a delay in treatment, which may negatively influence patient care7. In developed countries, at least 60% of the maternal post-natal deaths8 are considered related to suboptimal treatment because of a delay in PPH diagnosis, as well as a delay in management of the third stage of labor, and therefore could be avoided4.…”

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confidence: 99%

Use of a Visual Aid in addition to a Collector Bag to Evaluate Postpartum Blood loss: A Prospective Simulation Study

Brooks

Legendre

Brun

et al. 2017

Sci Rep

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Postpartum hemorrhage (PPH) is one of the most common causes of mortality in obstetrics worldwide. The accuracy of estimated blood loss is a priority in determining appropriate treatment. Will the additional use of a visual aid improve physicians’ accuracy in estimating blood loss compared to the use of a collector bag and baby scale alone? Simulation training sessions created three vaginal delivery scenarios for participants to estimate volumes of blood loss: firstly, using only a collector bag and a baby weight scale and secondly, adding a visual aid depicting known volumes of blood. The primary endpoint was to determine if participants could accurately evaluate blood loss within a 20% error margin. The addition of the visual estimator resulted in overestimation of blood loss. The rates of participants’ estimations were significantly more accurate when using the collector bag with the baby weight scale without the addition of the visual aid; 85.5% versus 33.3% (p < 0.01) for 350 mL, 88.4% versus 50.7% (p < 0.01) for 1100 mL and 88.4% versus 78.3% (p < 0.01) for 2500 mL, respectively. Additional use of a visual aid with a collector bag does not seem to be useful in improving the accuracy in the estimation of blood loss.

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Ten Years of Confidential Inquiries Into Maternal Deaths in France, 1998–2007

Abstract: : III.

Cited by 122 publications

References 23 publications

Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study)

Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study)

Invasive therapies for primary postpartum haemorrhage: a population‐based study in France

Use of a Visual Aid in addition to a Collector Bag to Evaluate Postpartum Blood loss: A Prospective Simulation Study

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