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Le Ray C, Pelage L, Seco A, Bouvier-Colle MH, Chantry AA, Deneux-Tharaux C. Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study. BJOG 2019; 126:1033-1041. [PMID: 30801948 DOI: 10.1111/1471-0528.15668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor. DESIGN Population-based cohort-nested case-control study. SETTING Six French regions in 2012/13. POPULATION Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM. METHODS Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis. MAIN OUTCOME MEASURES Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses). RESULTS The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO. CONCLUSION The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy. TWEETABLE ABSTRACT The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means.
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Affiliation(s)
- C Le Ray
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Port Royal Maternity Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, DHU Risks and Pregnancy, Paris Descartes University, Paris, France
| | - L Pelage
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Obstetrics and Gynaecology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
| | - A Seco
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,URC-CIC Paris Descartes Necker/Cochin, AP-HP, Cochin Hospital, Paris, France
| | - M-H Bouvier-Colle
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - A A Chantry
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - C Deneux-Tharaux
- Inserm UMR 1153 Obstetric, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Cheulot P, Saucedo M, Bouvier-Colle MH, Deneux Tharaux C, Kayem G. [Maternal mortality among women with Marfan syndrome or vascular Ehlers-Danlos syndrome in France, 2001-2012]. ACTA ACUST UNITED AC 2018; 47:30-35. [PMID: 30497941 DOI: 10.1016/j.gofs.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe maternal deaths in France associated with Marfan's syndrome or vascular Ehlers-Danlos syndrome. STUDY DESIGN A retrospective descriptive study based on data from the national confidential enquiry into maternal deaths, in France, during 2001-2012. Characteristics of the patients, their pregnancies and details of their deaths were analysed. The specific maternal mortality ratio by Marfan's syndrome or vascular Ehlers-Danlos syndrome was estimated. RESULTS Among 973 maternal deaths that occurred during the study period, five (0.4%) had a Marfan's syndrome (n=3) or a vascular Ehlers-Danlos syndrome (n=2), confirmed or suspected. The maternal mortality ratio due to Marfan's syndrome or vascular Ehlers-Danlos syndrome between 2001 and 2012 was 0.04/100,000 live births (IC 95% [0.011-0.2]). Three maternal deaths were caused by aortic dissections and two by other arterial ruptures. The deaths have occurred after 37 weeks of pregnancy for 4 patients, and at fifteen days of post-partum for one patient. The median age of death was 30 years. Three patients were nulliparous. Marfan's syndrome and vascular Ehlers-Danlos syndrome were not identified before the death of these five patients. CONCLUSION Five patients with, or suspected to have, Marfan's syndrome or vascular Ehlers-Danlos syndrome were identified. Early diagnosis of these syndromes in pregnant women before life threatening events is very important, especially to refer them to appropriate care.
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Affiliation(s)
- P Cheulot
- Service de gynécologie-obstétrique, hôpital Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue du Dr Arnold-Netter, 75012 Paris, France.
| | - M Saucedo
- Inserm U1153, équipe EPOPé, épidémiologie obstétricale périnatale et pédiatrique, centre de recherche en statistiques et épidémiologie, université Paris Descartes, DHU risques et grossesse, 53, avenue de l'observatoire, 75014 Paris, France
| | - M H Bouvier-Colle
- Inserm U1153, équipe EPOPé, épidémiologie obstétricale périnatale et pédiatrique, centre de recherche en statistiques et épidémiologie, université Paris Descartes, DHU risques et grossesse, 53, avenue de l'observatoire, 75014 Paris, France
| | - C Deneux Tharaux
- Inserm U1153, équipe EPOPé, épidémiologie obstétricale périnatale et pédiatrique, centre de recherche en statistiques et épidémiologie, université Paris Descartes, DHU risques et grossesse, 53, avenue de l'observatoire, 75014 Paris, France
| | - G Kayem
- Service de gynécologie-obstétrique, hôpital Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue du Dr Arnold-Netter, 75012 Paris, France; Inserm U1153, équipe EPOPé, épidémiologie obstétricale périnatale et pédiatrique, centre de recherche en statistiques et épidémiologie, université Paris Descartes, DHU risques et grossesse, 53, avenue de l'observatoire, 75014 Paris, France
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Kayem G, Dupont C, Bouvier-Colle MH, Rudigoz RC, Deneux-Tharaux C. Invasive therapies for primary postpartum haemorrhage: a population-based study in France. BJOG 2015; 123:598-605. [DOI: 10.1111/1471-0528.13477] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G Kayem
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
- Department of Obstetrics and Gynaecology; APHP; Trousseau Hospital; Université Pierre et Marie Curie; Paris France
| | - C Dupont
- Aurore Perinatal Network; Hôpital de la Croix Rousse; Hospices Civils de Lyon; Lyon France
| | - MH Bouvier-Colle
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
| | - RC Rudigoz
- Aurore Perinatal Network; Hôpital de la Croix Rousse; Hospices Civils de Lyon; Lyon France
| | - C Deneux-Tharaux
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
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Bouvier-Colle MH, Mohangoo AD, Gissler M, Novak-Antolic Z, Vutuc C, Szamotulska K, Zeitlin J. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe. BJOG 2012; 119:880-9; discussion 890. [PMID: 22571748 PMCID: PMC3472023 DOI: 10.1111/j.1471-0528.2012.03330.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. DESIGN Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. SETTING Twenty-five countries in the European Union and Norway. POPULATION Women giving birth in participating countries in 2003 and 2004. METHODS Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. MAIN OUTCOME MEASURES Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. RESULTS In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100,000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). CONCLUSIONS Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended.
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Affiliation(s)
- M-H Bouvier-Colle
- Institut National de la Santé et de la Recherche médicale-Unité Recherche épidémiologique en santé périnatale et santé des femmes et des enfants, UMR S Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, UPMC University Paris, France.
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Abstract
OBJECTIVES To assess the risk of postpartum maternal death associated with region, and to examine whether the quality of care received by the women who died differed by region. DESIGN A national case-control study. SETTING France. POPULATION Selected from recent nationwide surveys, 328 postpartum maternal deaths from 2001 through 2006 as cases; and a representative sample (n = 14 878) of women who gave birth in 2003 as controls. METHODS Crude and adjusted odds ratios (aOR) of maternal death associated with region were calculated with logistic regression, and the quality of care for women who died was compared according to region with chi-square tests or Fisher's exact tests. MAIN OUTCOME MEASURES Risk of postpartum maternal death associated with region, and quality of care. RESULTS After adjustment for maternal age and nationality, the risk of maternal death was higher in the Ile-de-France region (aOR 1.6, 95% CI 1.2-2.0) and the overseas districts (aOR 3.5, 95% CI 2.4-5.0) than in the group for the rest of continental France. In both regions, the excess risk of death from haemorrhage, amniotic fluid embolism and hypertensive disorders was significant. In continental France, after further controlling for women's obstetric characteristics, the risk of maternal death in Ile-de-France remained higher (aOR 1.8. 95% CI 1.3-2.6). The women in the cases groups received suboptimal care more frequently in Ile-de-France than in the other continental regions (64% versus 43%, P = 0.01). CONCLUSIONS These results suggest that quality of care and organisation of health services may play a role in the differential risk of maternal mortality between regions in France. Research on severe maternal morbidity and its determinants is needed to clarify the mechanisms involved.
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Affiliation(s)
- M Saucedo
- INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, UPMC University, Paris, France.
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Bouvier-Colle MH, Saucedo M, Deneux-Tharaux C. [The confidential enquiries into maternal deaths, 1996-2006 in France: what consequences for the obstetrical care?]. ACTA ACUST UNITED AC 2011; 40:87-102. [PMID: 21315522 DOI: 10.1016/j.jgyn.2010.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/03/2010] [Accepted: 12/23/2010] [Indexed: 11/26/2022]
Abstract
The national confidential enquiry into maternal deaths (ENCMM) and its committee (CNEMM) have the target to study all maternal deaths occurring in France, in order to expertise the care provided. The current report covers the 1996--year of the ENCMM establishment--to 2006 years. After being informed of the potential maternal deaths by the Epidemiological center on medical causes of deaths (CépiDC), and agreement from the medical doctors concerned, two assessors (one anesthetist and one obstetrician) gather the medical or obstetrical information near the team involved in the care of the women, by the mean of a detailed and specific questionnaire. The completely anonymous files are expertised by the CNEMM. Maternal mortality rates have been calculated by periods, the distribution of the obstetrical causes and the characteristics of the dead women were calculated too. The substandard care and the avoidability of deaths were estimated by subgroup. Since 1996 to 2006, 729 maternal deaths were included of which 553 were expertised. The majority of maternal deaths were due to direct obstetrical causes (73%) mainly haemorrhages (22%), amniotic fluid embolism (12%), complications of hypertension (10 %), and venous thrombo-embolism (around 10 % each). Half of maternal deaths were considered preventable by the CNEMM, particularly haemorrhage and sepsis. The factors of avoidability are delay to treat (31%) inadapted therapeutics (28%), even professional default (20%) no diagnosis (15%) or reluctant patient (7%). Seven deaths are discussed in a specific section including a detailed description of, and recommendations on how the quality of care may be improved.
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Affiliation(s)
- M-H Bouvier-Colle
- Unité 953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, UMRS 953 UPMC, Institut national de la santé et de la recherche médicale, université Paris 06, hôpital Tenon, bâtiment recherche, 4, rue de la Chine, 75020 Paris, France.
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Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle MH, Rudigoz R. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG 2010; 117:1278-87. [PMID: 20573150 DOI: 10.1111/j.1471-0528.2010.02648.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Decreasing the prevalence of severe postpartum haemorrhages (PPH) is a major obstetrical challenge. These are often considered to be associated with substandard initial care. Strategies to increase the appropriateness of early management of PPH must be assessed. We tested the hypothesis that a multifaceted intervention aimed at increasing the translation into practice of a protocol for early management of PPH, would reduce the incidence of severe PPH. DESIGN Cluster-randomised trial. POPULATION 106 maternity units in six French regions. METHODS Maternity units were randomly assigned to receive the intervention, or to have the protocol passively disseminated. The intervention combined outreach visits to discuss the protocol in each local context, reminders, and peer reviews of severe incidents, and was implemented in each maternity hospital by a team pairing an obstetrician and a midwife. MAIN OUTCOME MEASURES The primary outcome was the incidence of severe PPH, defined as a composite of one or more of: transfusion, embolisation, surgical procedure, transfer to intensive care, peripartum haemoglobin decrease of 4 g/dl or more, death. The main secondary outcomes were PPH management practices. RESULTS The mean rate of severe PPH was 1.64% (SD 0.80) in the intervention units and 1.65% (SD 0.96) in control units; difference not significant. Some elements of PPH management were applied more frequently in intervention units-help from senior staff (P = 0.005), or tended to - second-line pharmacological treatment (P = 0.06), timely blood test (P = 0.09). CONCLUSION This educational intervention did not affect the rate of severe PPH as compared with control units, although it improved some practices.
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Affiliation(s)
- C Deneux-Tharaux
- INSERM, UMR S953, UPMC, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Paris, France.
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Deneux-Tharaux C, Saucedo M, Bouvier-Colle MH. Pulmonary embolism in pregnancy. Lancet 2010; 375:1778; author reply 1778-9. [PMID: 20494721 DOI: 10.1016/s0140-6736(10)60799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Deneux-Tharaux C, Audureau E, Lefevre P, Brucato S, Morello R, Dreyfus M, Bouvier-Colle MH. Author response to: Factors relating to a rising incidence of major postpartum haemorrhage. BJOG 2010. [DOI: 10.1111/j.1471-0528.2009.02459.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mbola Mbassi S, Mbu R, Bouvier-Colle MH. [Delay in the management of obstetric complications: study in 7 maternity units in Cameroon]. Med Trop (Mars) 2009; 69:480-484. [PMID: 20025179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The purpose of this retrospective, descriptive study conducted in 7 third-level maternity units in Cameroon was to determine maternal mortality rates associated with obstetrical complications and correlate these data with competency of health-care staff and time-to-care. Consolidated data for the year 2004 were used to calculate various indicators of maternal health. During the study period 16,005 deliveries were performed with 15,322 live births. Obstetrical complications occurred in 2847 cases leading to a total of 112 maternal deaths. Overall maternal mortality was 699 deaths for 100,000 live births. The complication fatality rate was 3.3 % and was correlated with both competency of health-care-staff and time-to-care (p < 0.05). In addition delayed for treatment was a determinant factor in maternal mortality since the risk of death increased with longer time-to-care.
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Affiliation(s)
- S Mbola Mbassi
- Unité de Recherches épidémiologiques en santé perinatale, en santé maternelle et infantile, INSERM 953, Maternité, Hôpital Tenon, Paris.
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Audureau E, Deneux-Tharaux C, Lefèvre P, Brucato S, Morello R, Dreyfus M, Bouvier-Colle MH. Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention. BJOG 2009; 116:1325-33. [PMID: 19538416 DOI: 10.1111/j.1471-0528.2009.02238.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a multifaceted intervention on practices for prevention, diagnosis and management of postpartum haemorrhage (PPH) and on the prevalence of major PPH in a French perinatal network. DESIGN Quasi-experimental before-and-after survey. SETTING All maternity units (n = 19) of a French administrative region, operating as a perinatal network. SAMPLE One representative sample of all women delivering in the network, one representative sample of women with PPH deliveries and an exhaustive sample of women with major PPH. METHODS The multifaceted intervention took place between February 2003 and March 2004. Information was retrospectively collected for two periods, 2002 (before the intervention) and 2005 (after). MAIN OUTCOME MEASURES Practices for prevention, diagnosis and management of PPH and prevalence of major PPH. RESULTS After the intervention, the pharmacological prevention of PPH increased from 58.8% to 75.9% of vaginal deliveries (P < 10(-4)), and the use of blood collecting bags from 3.9% to 76.3% (P < 10(-4)), but initial PPH management did not change significantly. However, the median delay for second-line pharmacological treatment was significantly shortened [from 80 min (35-130) in 2002 to 32.5 min (20-75) in 2005]. An increase was observed in the use of surgery for PPH (0.06% versus 0.12% of deliveries; P = 0.03) and in blood transfusions (0.18% versus 0.33%; P = 0.01). The prevalence of major PPH did not change (0.80% versus 0.86% of deliveries; P = 0.62). CONCLUSIONS The intervention was effective at improving PPH-related preventive and diagnostic practices in a perinatal network. Improving management practices and reducing the prevalence of major PPH might require a different intervention design.
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Affiliation(s)
- E Audureau
- INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, UPMC Univ Paris 06, Paris, France
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Lefèvre P, Brucato S, Mayaud A, Morello R, Deneux-Tharaux C, Bouvier-Colle MH, Dreyfus M. [Impact of a new regional management for postpartum hemorrhages by an audit of severe cases: a before and after study (2002-2005)]. ACTA ACUST UNITED AC 2009; 38:209-19. [PMID: 19375245 DOI: 10.1016/j.jgyn.2009.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 02/14/2009] [Accepted: 03/02/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is still the first cause of maternal mortality in France. Most of these cases include inappropriate management. In 2004, regional guidelines were diffused to all the birthplaces in Basse-Normandie. To assess the impact of this regional management, an epidemiological study "before-after" (2002-2005) has been performed. Part of this study was the evaluation of the management of severe PPH. OBJECTIVE This study assessed the quality of care for major PPH and the correct follow-up of the guidelines before and after 2004. MATERIAL AND METHODS A clinical audit has been conducted in all the birthplaces from the region to assess the management of all severe PPH identified during 2002 and 2005. PPH were considered as severe when they presented one or more of the following: blood transfusion, uterine embolisation, hemostatic surgery, difference in hemoglobin rates greater than 4 g / dl, or maternal death. All of these cases have been analysed except those defined by hemoglobin difference. Assessment has been carried out by pairs of practitioners (obstetrician and anesthetist) blinded to the origin of the case. Criteria assessed were the quality of care for major PPH, the correct follow-up of the guidelines and the degree of severity of the PPH which was estimated as moderate or severe on clinical arguments. RESULTS The number of severe PPH was 34 in 2002 and 63 in 2005. The quality of care was increased with rates of inadequate management falling from 32 to 13% (p < 0,02), respectively. The follow-up of the guidelines was correct in the whole area, most of the criteria having been respected in about 90% of cases in 2005. However, active management of the third stage of delivery was only conducted in 71% of cases. The rates of severe PPH were not significantly different between 2002 (44%) and 2005 (38%). CONCLUSION The originality from this study is that the modifications of the practices were conducted at a regional level in order to enhance the management of PPH. The assessment which was performed showed that quality of care was improved all over the area but that there is still place to progress.
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Affiliation(s)
- P Lefèvre
- Service de la maternité, CHRU de Caen, 14033 Caen cedex, France.
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Deneux-Tharaux C, Macfarlane A, Winter C, Zhang WH, Alexander S, Bouvier-Colle MH. Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe. BJOG 2008; 116:119-24. [DOI: 10.1111/j.1471-0528.2008.01996.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Philibert M, Deneux-Tharaux C, Bouvier-Colle MH. Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care? BJOG 2008; 115:1411-8. [DOI: 10.1111/j.1471-0528.2008.01860.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Winter C, Macfarlane A, Deneux-Tharaux C, Zhang WH, Alexander S, Brocklehurst P, Bouvier-Colle MH, Prendiville W, Cararach V, van Roosmalen J, Berbik I, Klein M, Ayres-de-Campos D, Erkkola R, Chiechi LM, Langhoff-Roos J, Stray-Pedersen B, Troeger C. Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe. BJOG 2007; 114:845-54. [PMID: 17567419 PMCID: PMC1974828 DOI: 10.1111/j.1471-0528.2007.01377.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2007] [Indexed: 01/15/2023]
Abstract
BACKGROUND The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe. OBJECTIVES The objectives were to ascertain and compare policies for management of the third stage of labour and immediate management of postpartum haemorrhage in maternity units in Europe following vaginal birth. DESIGN Survey of policies. SETTING The project was a European collaboration, with participants in 14 European countries. SAMPLE All maternity units in 12 countries and in selected regions of two countries in Europe. METHODS A postal questionnaire was sent to all or a defined sample of maternity units in each participating country. MAIN OUTCOME MEASURES Stated policies for management of the third stage of labour and the immediate management of postpartum haemorrhage. RESULTS Policies of using uterotonics for the management of the third stage were widespread, but policies about agents, timing, clamping and cutting the umbilical cord and the use of controlled cord traction differed widely. For immediate management of postpartum haemorrhage, policies of massaging the uterus were widespread. Policies of catheterising the bladder, bimanual compression and in the choice of drugs administered were much more variable. CONCLUSIONS Considerable variations were observed between and within countries in policies for management of the third stage of labour. Variations were observed, but to a lesser extent, in policies for the immediate management of postpartum haemorrhage after vaginal birth. In both cases, policies about the pharmacological agents to be used varied widely.
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Affiliation(s)
- C Winter
- School of Nursing and Midwifery, University of DundeeDundee, UK
| | - A Macfarlane
- Department of Midwifery, City UniversityLondon, UK
| | | | - W-H Zhang
- Perinatal Epidemiology Research Unit, Université Libre de BruxellesBrussels, Belgium
| | - S Alexander
- Perinatal Epidemiology Research Unit, Université Libre de BruxellesBrussels, Belgium
| | | | | | - W Prendiville
- Department of Obstetrics and Gynaecology, Royal College of Surgeons of Ireland, Coombe HospitalDublin, Ireland
| | - V Cararach
- Hospital Clínic, IDIBAPS, University of BarcelonaBarcelona, Spain
| | | | - I Berbik
- Hungarian Society of Obstetrics and GynaecologyBudapest, Hungary
| | - M Klein
- Hanusch-Krankenhaus Gynakolog, University of ViennaVienna, Austria
| | | | - R Erkkola
- University Central Hospital of TurkuTurku, Finland
| | - LM Chiechi
- Unita di Obstetrica e gynecologia policlinica, University of BariBari, Italy
| | - J Langhoff-Roos
- Department of Obstetrics and Gynaecology, University of CopenhagenCopenhagen, Denmark
| | | | - C Troeger
- Pränatale Medizin, Universitäts FrauenklinikBasel, Switzerland
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Bouvier-Colle MH, Deneux C, Szego E, Couet C, Michel E, Varnoux N, Jougla E. [Maternal mortality estimation in France, according to a new method]. ACTA ACUST UNITED AC 2004; 33:421-9. [PMID: 15480282 DOI: 10.1016/s0368-2315(04)96550-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Ten years after implementation of maternal mortality monitoring in France, we established a new estimate of the current maternal mortality ratio (MMR) and revisited maternal death data collection. MATERIAL AND METHODS Linkages were set up between female deaths and childbirths and between female deaths and causes of death. Information provided by confidential inquiries into maternal deaths carried out by the National Committee for maternal mortality study was added. The World Health Organization (WHO) definitions were used for maternal death and maternal mortality ratio. The study concerned deaths occurring in 1999. Results were compared with data from 1989. RESULTS The official data showed 20% fewer maternal deaths than our inquiry. Estimated from our data, the MMR was 9 per 100000 live births in 1999. Direct obstetric causes were more often recorded than indirect causes. Hemorrhage was the leading obstetric cause of maternal death (21%). In comparison with the 1989-90 data, the underestimation of maternal deaths and maternal mortality ratios are improving (from 18 to 9 per 100000). CONCLUSION These results, obtained while the mean maternal age at childbirth increased regularly, are interpreted as a sign of improvement in care. But the persistence of post partum hemorrhages as the leading cause of maternal death and the high rate of avoidable deaths, disclose important targets for further progress.
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Affiliation(s)
- M-H Bouvier-Colle
- INSERM, Unité 149, Recherches épidémiologiques en santé périnatale et santé de la reproduction, Maternité Hôpital Tenon, 4, rue de la Chine, 75020 Paris.
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Szego-Zguem E, Bouvier-Colle MH. [Time course of maternal mortality in France since 1980]. Rev Epidemiol Sante Publique 2003; 51:361-4. [PMID: 13130216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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Bouvier-Colle MH. [Maternal mortality in developing countries: statistical data and improvement in obstetrical care]. Med Trop (Mars) 2003; 63:358-65. [PMID: 14763289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Since launching of the safe motherhood initiative in 1987, much work has been undertaken, understanding of the situation in developing countries has improved, and numerous health programs have been designed. However the end result of action has been considered disappointing more often than encouraging especially in Sub Saharan Africa. What is the true picture? The purpose of this article is to review the means available for studying all facets of maternal mortality and methodological precautions that must be applied in the interpretation of statistical data. Perusal of recent reports on maternal mortality reveals that estimated incidences in different populations vary widely from 85 to 1000 per 100,000 live births, that rural zones are more affected than urban areas, that reductions have been achieved in the major cities, that the most common direct obstetrical causes are postpartum hemorrhage, dystocia with uterine rupture, eclampsia, and sepsis, and that 70% of deaths are avoidable, i.e., due to absent or insufficient care. Although currently underused, qualitative study methods are gradually being implemented and will identify the health care sectors requiring priority improvement. Based on previous experience, it is unlikely that technical or obstetrical measures and action on the part of medical professionals alone will achieve any reduction in maternal mortality without the commitment of political authorities.
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Bouvier-Colle MH. [Confidential enquiries and medical expert committees: a method for evaluating healthcare. The case of Obstetrics]. Rev Epidemiol Sante Publique 2002; 50:203-17. [PMID: 12011736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Confidential inquiries into dramatic events are a specific type of audit used to measure quality of care. Confidential inquiries have been conducted on maternal deaths in some European countries since 1920-30. In France, the first one was carried out in 1996. The number of these surveys is increasing, including in developing countries. Initially implemented in perinatology, they are also being carried out in other surgical or medical areas. The aim of this work was to describe the methods used and demonstrate their contribution to evaluating healthcare services. METHODS We reviewed the literature and studied several confidential inquiries. These inquiries were in-depth examinations conducted by peers of medical events leading to critical outcomes. They were based on scientific reasoning in an attempt to explain what happened. Strict confidentiality, for patients and healthcare providers, was assured. The different steps and rules of investigation were clearly defined. RESULTS About twenty confidential inquiries concerning perinatal events have been published worldwide. Other inquiries concerning anesthetic accidents, stroke with hypertension, or surgical complications have also been reported. Their principal contribution lies in the capacity to identify weaknesses in the healthcare service and care organization. Suboptimal care and avoidable factors of death were found in all cases. Most of the reports led to recommendations. These inquiries provide essential information for reorganizing current healthcare practices. CONCLUSION Confidential inquiries are needed to complete standard epidemiology surveys in evaluating healthcare and healthcare organization.
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Affiliation(s)
- M H Bouvier-Colle
- INSERM, Unité 149 - Recherches épidémiologiques en santé périnatale et santé des femmes, 123, boulevard Port-Royal, 75014 Paris, France
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Dumont A, De Bernis L, Bouillin D, Gueye A, Dompnier JP, Bouvier-Colle MH. [Maternal morbidity and qualification of health-care workers: comparison between two different populations in Senegal]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:70-9. [PMID: 11976580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE High fertility rates and high maternal mortality ratios have led most cooperation agencies to place high priority on health of women and children. The objective of this study was to compare maternal morbidity and mortality tin two populations with widely contrasting availability of health care in order to test the hypothesis that differences in maternal outcome mainly result from the qualification of health carers. METHODS This population-based study included a cohort of pregnant women which was part of a multicenter study of maternal morbidity in six countries in West Africa (MOMA). We compared health outcome in two different populations of Senegal (Saint-Louis and Kaolack).3,777 pregnant women were follow through pregnancy, delivery and pureperium. Maternal morbidity was assessed from the women's recall at each visit of the investigator and from obstetric complications diagnosed by the birth attendant within health facilities. RESULTS Maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centers, most often assisted by traditional birth attendants, than in Saint-Louis where women giving birth in health facilities were principally referred to the regional hospital and were generally assisted by midwives (874 and 151 maternal deaths per 100,000 live births respectively, p<0.01). Diagnosed maternal morbidity, however, was higher in Saint-Louis than in the Kaolack area, especially for births in health facilities (9.50 and 4.84 episodes of obstetric complications per 100 lie births respectively, p<0.01). Univariate and multivariate analyses showed that diagnosed morbidity was mainly associated with degree of training of the health attendant in facility deliveries and that antenatal care had no effect. DISCUSSION Midwives in health facilities appear to detect more obstetric complications than traditional birth attendants. Immediate detection leads to immediate care and to a lower case-fatality rate. This could explain the differences in maternal outcome between two urban centers with contrasting health care availability. CONCLUSION These results suggest that one of the strongest weapons in the fight against maternal mortality is the employment of the most qualified personnel possible for monitoring labor.
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Affiliation(s)
- A Dumont
- INSERM Unité 149, Recherches épidémiologiques en santé périnatale et santé des femmes, 123, boulevard de Port-Royal, 75014 Paris, France
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Ould El Joud D, Bouvier-Colle MH. [Dystocia: frequency and risk factors in seven areas in West Africa]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:51-62. [PMID: 11976578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES 1) To measure the incidence of dystocia in six cites and one rural area in West Africa. 2) To identify risk factors of dystocia and analyze their interrelationships with the goal to potentially use them to identify high-risk pregnant women attending antenatal consultations. (3) To assess their usefulness as predictors of dystocia during pregnancy. METHODS The MOMA study is a prospective population-based follow-up study of 20,326 pregnant women in West Africa. Due to the likely diagnostic and recall bias for home deliveries, risk factors for dystocia were analyzed only for deliveries in health facilities. A total of 16,318 deliveries were analyzed. RESULTS The incidence of dystocia was 18.3% (95%CI: 17.7-18.9). Multivariate analysis using stepwise logistic regression disclosed the following significant risk factors: short stature, scarred uterus, nulliparity. Positive predictive values were very low for both univariate and multivariate analysis. CONCLUSION The incidence of dystocia, which occurs mainly at delivery, is high in West Africa. Consequences are often dramatic, both for the fetus and the mother. None of the risk factors studied, even when used in combination, provided a good prediction of dystocia. All pregnant women should therefore be considered at risk of dystocia. Efforts should be made to detect dystocia during labor (partography) and to provide good-quality emergency obstetric care. Emergency obstetric care must be made available to all pregnant women. This goal can be achieved in most of the major West African cities. More facilities offering good-quality cesarean section must be made available.
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Affiliation(s)
- D Ould El Joud
- Direction de la Planification, Coopération et Statistiques, Ministère de la Santé et des Affaires Sociales, Nouakchott, Mauritanie
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Dumont A, De Bernis L, Bouvier-Colle MH, Bréart G. [Estimate of expected cesarean section rate for maternal indications in a population of pregnant women in West Africa (MOMA survey)]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:107-12. [PMID: 11976584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES There is still some debate about the optimal rate of cesarean section (CS) needed to achieve better outcome for both mothers and infants in developing countries. We examine here two aspects of the question: i) a simple method to estimate the expected rate of CS according to obstetrical risk; ii) a test of the method to estimate the appropriate rate for maternal indications in a general population of pregnant women in West Africa. METHODS This population-based study was conducted in a cohort of pregnant women in six West African countries (MOMA survey): Abidjan (Ivory Coast), Bamako (Mali), Niamey (Niger), Nouakchott (Islamic Republic of Mauritania), Ouagadougou (Burkina Faso), and in three areas of Senegal, two small towns (Fatick and Kafrine, Kaolack region), and one major city (Saint-Louis). 19,459 women with singleton pregnancies with expected breech presentation were followed to delivery and puerperium. Maternal indications for CS were defined as dystocia (prolonged labor over 12 hours), malpresentation, previous cesarean section, abruptio placentae, placenta paevia and eclampsia. A standardized method was used to calculate the number of expected CS in the MOMA population, according to the level of the obstetrical risk. RESULTS The minimal needs for Cs for maternal indications were estimated between 3.6 and 6.5 per 100 deliveries. However, we observed a rate of 1.3 CS per 100 deliveries. DISCUSSION These findings underline the lack of CS for maternal indications in urban West Africa. The method of standardization we propose could help policy makers, health planners and obstetricians to design programs to reach the appropriate level of CS and to monitor and follow-up these programs.
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Affiliation(s)
- A Dumont
- INSERM Unité 149, Recherches Epidémiologiques en Santé Périnatale et Santé des Femmes, 123, boulevard Port-Royal, 75014 Paris, France
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Bouvier-Colle MH. [Why a special issue for maternal health in French speaking Africa?]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:40-3. [PMID: 11976576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- M H Bouvier-Colle
- Institut National de la Santé et de la Recherche Médicale, Unité 149 Recherches épidémiologiques en santé périnatale et santé des femmes, Maternité, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Ouédraogo C, Bouvier-Colle MH. [Maternal mortality in West Africa: risk, rates, and rationale]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:80-9. [PMID: 11976581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
New information has been collected about maternal mortality which is becoming better known in the West African countries. However, estimated rates for these countries still exhibit wide discrepancies related to the methods used. The purpose of the present work was to describe the principal methods which can be used to estimate rates and to present the results observed in the six countries of the MOMA survey. Obstetrical causes of maternal death and their substandard care, pointed out by the audit carried out during the survey, are presented and discussed.
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Affiliation(s)
- C Ouédraogo
- Centre Hospitalier National de Ouagadougou, Burkina Faso
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Bouvier-Colle MH, Péquignot F, Jougla E. [Maternal mortality in France: frequency, trends and causes]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30:768-75. [PMID: 11917728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Ten years ago the first epidemiological surveys on maternal mortality in France were carried out on the national level. In 1995, a National Committee of Medical Experts was created to conduct confidential inquiries into maternal deaths. It is thus useful to examine the general picture of maternal mortality in France drawn by the routinely and permanently collected data. These statistics are collected independently of the procedure adopted by the National Committee on confidential inquiries into maternal deaths. National death and cause-of-death registries have recorded maternal death rates for several years with data by age, area of residence, nationality, and direct or indirect obstetric causes. The low and underestimated rate of 8.5 maternal deaths per 100,000 live births recorded in 1989 increased regularly up to 1992. Currently the rates have been around 9 to 13 with no evidence of a declining trend. The larger urban area around Paris (Ile-de-France) has shown a statistically significant higher rate over the last several years. Post-partum hemorrhage remains the leading cause of maternal death. Compared with other European countries, maternal mortality in France is in an average position, similar to Great Britain (12 per 100,000), but higher than in Scandinavian countries. The elevated mean age of mothers at delivery is one explanation for the lack of a decline in the rate of maternal deaths expected until 2005 although further actions should be implemented to attempt to lower the rate to that observed in Scandinavian countries. A pertinent classification of causes of maternal deaths allowing valid international comparisons would be useful for helping answer the questions raised by clinicians.
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Affiliation(s)
- M H Bouvier-Colle
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 149, Recherches épidémiologiques en santé périnatale et santé maternelle, 123, boulevard Port-Royal, 75014, Paris.
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Abstract
INTRODUCTION Rates of caesarean sections in more-developed countries have been rising since 1970, and vary greatly between less-developed countries. Present estimates, based on data from more-developed countries need to be validated with data from less-developed countries. We estimated the need for caesarean section for maternal indication in a population of pregnant women in west Africa (MOMA survey). METHODS The expected caesarean section rate was calculated from the rate of obstetric risk in the MOMA population, and rates of caesarean section in published work. FINDINGS Three-quarters of women from hospitals of sub-Saharan Africa were delivered by caesarean section for maternal reasons. Such intervention was needed for six main reasons, protracted labour, abruptio placentae, previous caesarean section, eclampsia, placenta praevia, and malpresentation. Although the observed rate of caesarean section in west African women is 1.3%, our results, combined with those of published work suggest a range of 3.6-6.5% (median, 5.4%). INTERPRETATION Our method might not be strictly accurate, but it is simple and provides informative findings that can help policy makers and health planners in sub-Saharan Africa to design and follow up programmes to reach the optimum caesarean section rate. Moreover, application of this method to hospital data could improve practitioners' assessments in these countries.
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Affiliation(s)
- A Dumont
- Epidemiological Research Unit on Women and Children's Health, National Institute of Health and Medical Research (INSERM), Paris, France.
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Girard F, Burlet G, Bayoumeu F, Fresson J, Bouvier-Colle MH, Boutroy JL. [Severe complications of pregnancy and delivery: the situation in Lorraine based on the European investigation]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30:S10-7. [PMID: 11883010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The level of maternal mortality appears to be higher in France than in other European countries according to the data collected in the 1995 European survey. We performed a retrospective analysis of severe hemorrhage, pregnancy induced hypertension, and maternal sepsis in 1995 in the Lorraine region and reviewed the management scheme used in each case. There was one maternal death and 223 cases of severe maternal morbidity (110 cases of hemorrhage, 105 cases of pregnancy induced hypertension, 8 cases of maternal sepsis). The frequency of these maternal diseases was an estimated 8 per 1000 births. Ninety percent of the children (90.7%) were living 7 days after birth. Pregnancy after the age of 35 years, obesity, and an intermediate level of vocational training were well-documented high risk factors in the Lorraine area. All of the women who developed complications had been followed regularly during their pregnancy. High parity and a scarred uterus were high risk factors for post partum hemorrhage. About 45% (45.5%) of the patients were transferred to an emergency unit for intensive care. Pregnancy-induced hypertension was treated within the normal hospital network, most of the mothers being transferred to a reference center prior to delivery. This retrospective study demonstrates the need for reporting more information on medical records. The data observed improved our knowledge of the prevalence and management of the main causes of direct maternal death in the Lorraine area. It improved our knowledge on the prevalence and management of the main causes of direct maternal death in Lorraine area.
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Affiliation(s)
- F Girard
- Service d'épidémiologie et d'évaluation cliniques, CHU de Nancy
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Bouvier-Colle MH, Varnoux N. [Maternal mortality and severe morbidity in 3 French regions: results of MOMS, a European multicenter investigation]. J Gynecol Obstet Biol Reprod (Paris) 2001; 30:S5-9. [PMID: 11883015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Maternal mortality rates vary between different European countries. One hypothesis put forward to explain such differences is the potential discrepancy in the incidence of the main obstetrical complications. A European concerted action designed to estimate the incidence of severe post partum hemorrhage (> 1.5 l), PET, and sepsis was carried out in 1995-96 (MOMS-B survey) using standardized definitions and the same questionnaire in all regions. In the 13 regions in Europe involved in the study, including Champagne-Ardenne, Center and Lorraine in France, 1843 cases of obstetrical complication were identified among 182,589 births. The overall mean rate of severe maternal morbidity was 10.1 for 1000 births. This rate was 8.0 for Lorraine, 6.7 for Champagne-Ardenne and 5.5 for Center. The rates of hemorrhage and PET in the United Kingdom, Belgium and Finland were twice the rates in France and Norway. The inverse was observed for sepsis. Such discrepancies between countries, despite the use of standardized definitions, raises several questions. Was the methodology correctly applied? Were threatening situations correctly assessed in France? Was disease severity assessed in the same way in all countries? Further studies would be required to answer these questions.
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Affiliation(s)
- M H Bouvier-Colle
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 149, Recherches Epidémiologiques en santé périnatale et santé maternelle, 123, bd Port-Royal, 75014 Paris.
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Bouvier-Colle MH, Ould El Joud D, Varnoux N, Goffinet F, Alexander S, Bayoumeu F, Beaumont E, Fernandez H, Lansac J, Lévy G, Palot M. Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions. BJOG 2001; 108:898-903. [PMID: 11563457 DOI: 10.1111/j.1471-0528.2001.00224.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage. DESIGN Retrospective questionnaire survey. SETTING Three administrative regions of France. POPULATION All women who were pregnant or had recently given birth during the year before the survey. METHODS A European survey (MOMS-B) defined severe haemorrhages as blood loss > or = 1500mL. A specific questionnaire was added in France to analyse the quality of care of these haemorrhages. The survey was carried out in three different administrative regions: Champagne-Ardenne, the Centre and Lorraine. An expert committee was appointed and began by establishing a framework for qualitative assessment. One hundred and sixty-five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and 'mixed' care were both considered substandard. The 165 cases were coded and then studied with uni- and multivariate analysis (logistic regression with SAS and SPSS software). RESULTS Of the 165 cases identified, 51% (85/165) were vaginal, 19% (31/165) operative vaginal, and 30% (49/165) caesarean. The leading cause of haemorrhage was uterine atony. Overall, 62% of the cases received appropriate care, 24% received totally inadequate care and 14% mixed care. After adjustment for sociodemographic factors, antenatal care and organisational aspects, the lack of a 24-hour on-site anaesthetist at the hospital and a low volume of deliveries (<500 births per year) were the factors associated with substandard care. CONCLUSION Organisational features are so important that application of good clinical practices for safer motherhood reinforce the need for new organisation of obstetric services. For the first time, the presence of an anaesthetist is shown to have a measurable effect on the quality of care for women giving birth. These results need to be confirmed by others.
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Affiliation(s)
- M H Bouvier-Colle
- Epidemiological Research Unit on Perinatal and Women's Health INSERM, National Institute of Health and Medical Research, Paris, France
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Lelong N, Kaminski M, Saurel-Cubizolles MJ, Bouvier-Colle MH. Postpartum return to smoking among usual smokers who quit during pregnancy. Eur J Public Health 2001; 11:334-9. [PMID: 11582616 DOI: 10.1093/eurpub/11.3.334] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many women stop smoking while they are pregnant, but the majority resume smoking in the postpartum. The objective is to describe postpartum tobacco use of women who quit during pregnancy and factors predicting postpartum smoking relapse. METHODS Secondary analysis of two surveys of new mothers. Survey A conducted in three maternity hospitals, including 685 women interviewed after birth and who answered a postal questionnaire at 5 months postpartum; survey B conducted in four 'départements' (administrative areas), including 636 women who answered a postal questionnaire at 6 months postpartum. Response rates were respectively 90% and 68%. Smoking status was recorded for three time periods: before pregnancy, during pregnancy, and at 5-6 months. Social characteristics and preventive behaviour were compared for regular smokers who had quit smoking during pregnancy and those who had not, and among quitters, who had resumed smoking postpartum and those who had not. RESULTS In survey A, 37% were smokers before pregnancy, 34% of them stopped during pregnancy, and among the latter, 48% had resumed smoking 5-6 months after delivery. In survey B, the percentages were respectively 43, 54 and 57%. The most predictive factor of postpartum smoking relapse was the partner's smoking behaviour. CONCLUSION Return to smoking after delivery is frequent, but nearly half of the regular smokers who had stopped during pregnancy were still non-smokers 5-6 months after the birth. However, to increase this proportion, interventions need to include partners, especially if they are smokers.
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Affiliation(s)
- N Lelong
- INSERM Unit 149, Epidemiological Research on Women's Health and Perinatal Health, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif, France
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Abstract
OBJECTIVES To determine the incidence of dystocia in seven west African cities, to attempt to discover what, if any, factors at the prenatal visit might identify women at risk of dystocia, and to assess the utility of such screening. METHOD This prospective population study of 20326 pregnant women in west Africa (MOMA) analyzed risk factors for dystocia on the basis of deliveries in health care facilities. RESULTS Incidence of dystocia was 18.3%. In the multivariate analysis, the risk factors were small stature, previous cesarean, and nulliparity. As screening tools these factors have inadequate positive predictive values, either singly or combined. CONCLUSION It is almost impossible to predict the occurrence of dystocia before the onset of labor. Therefore, labor must be carefully monitored, and there must be health care facilities available that can manage complications, especially cesarean deliveries. If such facilities are not accessible, an effective referral system must be established.
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Affiliation(s)
- D Ould El Joud
- Direction de la Planification, Co-opération et Statistiques, Ministère de la Santé et des Affaires Sociales, Nouakchott, Mauritania.
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Affiliation(s)
- S Alexander
- Ecole de Santé Publique, Université Libre de Bruxelles, Belgium.
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Bouvier-Colle MH, Ouedraogo C, Dumont A, Vangeenderhuysen C, Salanave B, Decam C. Maternal mortality in West Africa. Rates, causes and substandard care from a prospective survey. Acta Obstet Gynecol Scand 2001; 80:113-9. [PMID: 11167204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND According to estimates of maternal mortality rates from WHO/UNICEF, the West African rates appear to be among the world's highest. The precision of these estimates from general mortality models is far from ideal and no information on the distribution of causes of death is provided. The principal objective of our study is to describe the maternal mortality, estimation of the rates and distribution of obstetric causes, from a population based survey of pregnant women carried out in West Africa. We also present the main characteristics of the deaths that occurred, including avoidable aspects. METHODS The survey included all the pregnant women living in seven defined areas, from December 1994 through June 1996, depending on the area. Twenty thousand three hundred and twenty-six pregnant women (94.3% of all those identified) agreed to participate and 19,545 were followed throughout the second trimester of pregnancy, delivery and the puerperium. Physicians from the survey team made special enquiries about all maternal deaths. But the deaths occurring during the first months of pregnancy could not be estimated. A subcommittee analyzed all the deaths, assigned the underlying cause and discussed the avoidable aspects of the death. RESULTS Sixty-six deaths were reported. Fifty-five (three late) were deaths due to obstetric causes; six were fortuitous deaths, and no cause could be defined for five. As a mean and for pregnancy after week 25, the maternal mortality rate was estimated at 311 (95% CI 234-404) per 100,000 live births and 852 (95% CI 456-1457) in rural areas. Hemorrhages accounted for 29% of obstetric deaths, uterine rupture 13%, eclampsia and infectious diseases 11% each. Seventy-four percent of the direct obstetric causes were considered avoidable. CONCLUSION Confidential enquiries into maternal deaths in West Africa are not just a concern of the others. They are urgently requested to promote the improvement of health services.
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Affiliation(s)
- M H Bouvier-Colle
- Institut National de la Santé et de la Recherche Médicale, Unité 149-Recherches épidémiologiques en santé périnatale et santé des femmes, Paris, France
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Chalumeau M, Salanave B, Bouvier-Colle MH, de Bernis L, Prual A, Bréart G. Risk factors for perinatal mortality in West Africa: a population-based study of 20326 pregnancies. MOMA group. Acta Paediatr 2000; 89:1115-21. [PMID: 11071095 DOI: 10.1080/713794568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
UNLABELLED The aim of the study was to identify simple clinical risk factors for perinatal mortality (PNM) in different areas of West Africa, to quantify their prevalence among pregnant women and to estimate their relative contribution in the definition of high-risk status of PNM. The MOMA study was a prospective population-based study in which data were collected on 20 326 pregnant women in various, primarily urban, areas of Burkina Faso, Ivory Coast, Mali, Mauritania, Niger and Senegal. The present report analyses 19 870 singleton births and 31 simple clinical variables with univariate and multivariate methods. The mean PNM ratio was 42 per 1000 total births, and 62% of these deaths were stillbirths. In the crude analysis, after adjustment or taking prevalence into account, the principal risk factors were: vaginal bleeding (immediately antenatal and intrapartum), hypertension (especially during labour), dynamic (prolonged labour and use of oxytocin) and mechanic (non-cephalic presentation) dystocia, and infection (prolonged rupture of the membranes and intrapartum fever). CONCLUSIONS Most of the principal risk factors for PNM cannot be detected during antenatal care visits but only in early labour. High-risk status should not be based solely on antenatal care visits, but should also take into account monitoring during labour.
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Affiliation(s)
- M Chalumeau
- Institut National de la Santé et de la Recherche Médicale, Unité 149 Recherches épidémiologiques sur la santé des femmes et des enfants, Paris, France
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Abstract
OBJECTIVES To present an analysis of the infant mortality trends and causes of death in France from the beginning of the 1950s, neonatal (0-27 days) and post-neonatal mortality (27-364 days) being considered separately. MATERIAL AND METHODS We used the data from the national registries of births computed by INSEE (National Institute of Statistics and Economic Surveys) and of causes of deaths computed by Inserm (National Institute of Health and Medical Research). We analysed the evolution of the infant death rates from 1950 to 1997, the overall mortality for males and the percentages of causes of death at three different periods. RESULTS Mortality has changed according to neonatal or post-neonatal ages. A constant improvement was recorded for neonatal mortality up to 1995 (2.9 per 1,000), while there was a stagnation for post-neonatal mortality between 1979 and 1993, followed by a sharp decrease (2.0 per 1,000 in 1995). During the neonatal age the main causes of death are conditions generated in the neonatal period and congenital abnormalities, both decreasing regularly; during the post-neonatal age the main cause is sudden infant death syndrome, which fell dramatically during the last four years. CONCLUSION Several factors related to medical care, nursing and type of registration are contributing simultaneously to the important variations in mortality found in our results.
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Affiliation(s)
- F Hatton
- Service d'information sur les causes médicales de décès, Inserm SC8, Le Vésinet, France
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Bouvier-Colle MH, Cot M, Le Goaster C. [Resp-informations]. Rev Epidemiol Sante Publique 2000; 48:215-24. [PMID: 10804430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Prual A, Bouvier-Colle MH, de Bernis L, Bréart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ 2000; 78:593-602. [PMID: 10859853 PMCID: PMC2560760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care.
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Affiliation(s)
- A Prual
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 149, Paris, France
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de Bernis L, Dumont A, Bouillin D, Gueye A, Dompnier JP, Bouvier-Colle MH. Maternal morbidity and mortality in two different populations of Senegal: a prospective study (MOMA survey). BJOG 2000; 107:68-74. [PMID: 10645864 DOI: 10.1111/j.1471-0528.2000.tb11581.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare maternal morbidity and mortality in two urban populations with contrasting availability of health care, and to test the hypothesis that differences in maternal outcome result mainly from the management of delivery in health facilities. DESIGN A population-based study of a cohort of pregnant women which was part of a multicentre study of maternal morbidity in six countries of western Africa (MOMA). SETTING Two different urban areas of Senegal (Saint-Louis and Kaolack). POPULATION 3,777 pregnant women who were followed up throughout pregnancy, delivery and puerperium. MAIN OUTCOME MEASURES Maternal morbidity and mortality: morbidity was assessed from women's recall at each visit by the investigator and from obstetric complications diagnosed by the birth attendant within health facilities. RESULTS Maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centres, usually assisted by traditional birth attendants, than in Saint-Louis where women giving birth in health facilities went principally to the regional hospital and were usually assisted by midwives (874 and 151 maternal deaths per 100,000 live births, respectively, P < 0 x 01). Maternal morbidity, however, was higher in Saint-Louis than in Kaolack area, especially for births in health facilities (9 x 50 and 4 x 84 episodes of obstetric complications per 100 live births, respectively, P < 0 x 01). Univariate and multivariate analyses showed that morbidity was mainly associated with the training of the birth attendant in facility deliveries and that antenatal care had no effect. CONCLUSION Midwives in health facilities appear to detect more obstetric complications than traditional birth attendants. Immediate detection leads to immediate care and to low fatality rates. This could explain differences in maternal outcome between two urban centres with contrasting health care availability. These results suggest that one of the strongest weapons in the fight against maternal mortality is the employment of the most qualified personnel possible for monitoring labour.
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Affiliation(s)
- L de Bernis
- Epidemiological Research Unit on Women and Children's Health INSERM U 149, National Institute of Health and Medical Research, Paris, France
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Bouvier-Colle MH. [Has the world program for maternal health bogged down?]. Sante Publique 1999; 11:101-2. [PMID: 10504829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Bertrais S, Larroque B, Bouvier-Colle MH, Kaminski M. [Infant temperament at 6-9 months old: validation of the French version of the Infant Characteristics Questionnaire and factors associated with measurement]. Rev Epidemiol Sante Publique 1999; 47:263-77. [PMID: 10422120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The aim of the study was to assess the validity of the French version of the Infant Characteristics Questionnaire (ICQ), which was developed by Bates in 1979 to investigate the parental perceptions of infant temperament at 6 months of age. METHODS The French version was established after translation/back-translation, and tested on a sample of 794 mothers, who gave birth in 1995 in four French Departments and who returned the questionnaire which was mailed 6 months after the birth. RESULTS The non-response rate of each item was very low (< 2%). Factor analysis resulted in the same four factors as in the American data: fussy/difficult, unadaptable, unpredictable, dull. However, some of the items did not have similar factor loadings. Thus new factor scores were defined for the French version of the ICQ. Internal consistency, as measured by the Cronbach coefficient, was satisfactory (> 0.7) for the factors fussy/difficult and unadaptable. It was lower, but acceptable (> 0.6) for the two other factors. The infant's temperament was not related to birth parameters. In contrast, some factor scores were significantly associated with parity, mother's education, as well as her health and the infant's health after leaving the maternity ward. CONCLUSIONS The French version of the ICQ is well accepted and has a good validity. This scale provides a useful instrument for research, especially for epidemiological studies on infant health and development, as well as their determinants.
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Larroque B, Kaminski M, Bouvier-Colle MH, Hollebecque V. Participation in a mail survey: role of repeated mailings and characteristics of nonrespondents among recent mothers. Paediatr Perinat Epidemiol 1999; 13:218-33. [PMID: 10214611 DOI: 10.1046/j.1365-3016.1999.00176.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study analysed the characteristics of respondent and nonrespondent mothers at each stage of a survey procedure, from a initial questionnaire to a reminder letter and two repeated mailings. Of 938 mothers of liveborn children who, while maternity inpatients, received a questionnaire and information about a mail survey to follow 2 months later, 828 completed and returned the initial questionnaire, 708 agreed to participate in the mail survey and were sent the mail questionnaire, and 612 finally completed and returned the questionnaire at 2 months. There were differences between respondents and non-respondents for socio-demographic factors at each stage of the process. The final response rate to the mail questionnaire was higher among mothers who were younger, were breast feeding, and had more education, an occupation and fewer children. The characteristics of late respondents were intermediate between those of early to middle respondents and nonrespondents for age, educational level, breast feeding and occupation. Maternal and infant health varied only slightly according to response status. Repeated mailings increased response and diminished selection. A mail questionnaire after contact in a maternity ward is a cost-effective means of gathering data about a large sample of recent mothers and their children.
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Ancel PY, Bouvier-Colle MH, Bréart G, Varnoux N, Salanave B, Benhamou D, Boutroy JL, Caillier I, Dumoulin M, Fernandez H, Papiernik E, Puech F. Risk factors for maternal condition at admission to an intensive care unit: does health care organisation play a role? Study Group of the Maternal Morbidity. J Perinat Med 1999; 26:354-64. [PMID: 10027130 DOI: 10.1515/jpme.1998.26.5.354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.
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Affiliation(s)
- P Y Ancel
- Epidemiological Research Unit on Women and Children's Health INSERM, National Institute of Health and Medical Research, Paris, France.
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Coeuret-Pellicer M, Bouvier-Colle MH, Salanave B. [Do obstetric causes of death explain the differences in maternal mortality between France and Europe?]. J Gynecol Obstet Biol Reprod (Paris) 1999; 28:62-8. [PMID: 10394518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
In view of understanding why the level of maternal mortality is higher in France than in other European countries, a specific study of frequency and causes has been carried out in these 13 countries. Two different sources of data were used: the annual civil death data from national offices which are published by the WHO, and the MOMS data. It was hypothesized that the pattern of causes plays a role in the level of maternal mortality. This hypothesis was checked with results issuing from a European concerted action where deaths were classified by a European group of medical experts using identical criteria. There were apparently more cases of hemorrhage, direct obstetric causes, and indirect obstetric causes in France than in the other European countries. The higher level of indirect obstetric causes may be explained by stronger registration regulations for maternal deaths recently implemented in France. Due to the higher level of hemorrhage as cause of maternal death in France, we suggest in-depth research is needed in the near future to study prevalence and management of obstetrical hemorrhage in France.
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Affiliation(s)
- M Coeuret-Pellicer
- INSERM Unité 149-Recherches épidémiologiques sur la santé des femmes et des enfants, Paris
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Salanave B, Bouvier-Colle MH, Varnoux N, Alexander S, Macfarlane A. Classification differences and maternal mortality: a European study. MOMS Group. MOthers' Mortality and Severe morbidity. Int J Epidemiol 1999; 28:64-9. [PMID: 10195666 DOI: 10.1093/ije/28.1.64] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare the ways maternal deaths are classified in national statistical offices in Europe and to evaluate the ways classification affects published rates. METHODS Data on pregnancy-associated deaths were collected in 13 European countries. Cases were classified by a European panel of experts into obstetric or non-obstetric causes. An ICD-9 code (International Classification of Diseases) was attributed to each case. These were compared to the codes given in each country. Correction indices were calculated, giving new estimates of maternal mortality rates. SUBJECTS There were sufficient data to complete reclassification of 359 or 82% of the 437 cases for which data were collected. RESULTS Compared with the statistical offices, the European panel attributed more deaths to obstetric causes. The overall number of deaths attributed to obstetric causes increased from 229 to 260. This change was substantial in three countries (P < 0.05) where statistical offices appeared to attribute fewer deaths to obstetric causes. In the other countries, no differences were detected. According to official published data, the aggregated maternal mortality rate for participating countries was 7.7 per 100,000 live births, but it increased to 8.7 after classification by the European panel (P < 0.001). CONCLUSION The classification of pregnancy-associated deaths differs between European countries. These differences in coding contribute to variations in the reported numbers of maternal deaths and consequently affect maternal mortality rates. Differences in classification of death must be taken into account when comparing maternal mortality rates, as well as differences in obstetric care, underreporting of maternal deaths and other factors such as the age distribution of mothers.
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Bouvier-Colle MH. [Healty motherhood, an example from Tunisia]. Rev Epidemiol Sante Publique 1998; 46:239-41. [PMID: 9690290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Jougla E, Bouvier-Colle MH. [Atlas of mortality in Europe]. Rev Epidemiol Sante Publique 1998; 46:241-4. [PMID: 9690291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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