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Published on: August 30, 2020
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Invasive therapies for primary postpartum haemorrhage: a population-based study in France
G Kayem1,2, C Dupont3, M H Bouvier-Colle1
1Inserm 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.
Summary
Maternal mortality from obstetric hemorrhage and invasive therapies for postpartum hemorrhage (PPH) are high in France. Findings suggest issues in initial PPH management and invasive procedure use.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Surgical Interventions
Background:
- Postpartum hemorrhage (PPH) remains a significant cause of maternal mortality worldwide.
- Effective management strategies are crucial to reduce associated morbidity and mortality.
- Invasive therapies are reserved for severe cases of PPH unresponsive to medical management.
Purpose of the Study:
- To characterize the use and outcomes of invasive therapies for primary postpartum hemorrhage (PPH).
- To evaluate the effectiveness and failure rates of different invasive PPH management techniques.
- To identify factors influencing the choice and success of invasive PPH treatments.
Main Methods:
- Population-based observational study across 106 maternity units in six French regions.
- Prospective data collection on 146,781 deliveries between 2004 and 2006.
- Analysis of women with PPH managed via uterine suture, pelvic vessel ligation, arterial embolization, or hysterectomy.
Main Results:
- Invasive therapy was used in 4.4% of PPH cases (0.2% of deliveries).
- Hysterectomy was performed in 1.1% of PPH cases (0.05% of deliveries).
- Conservative invasive therapies (embolization or surgery) had an overall failure rate of 15.6%, higher with surgical procedures, especially in vaginal deliveries.
Conclusions:
- High rates of maternal mortality from obstetric hemorrhage and invasive PPH therapies were observed in France.
- These findings indicate potential deficiencies in the initial management of PPH.
- Inadequate utilization or application of invasive procedures for PPH management may be contributing to adverse outcomes.
