Épidémiologie de la mortalité maternelle en France, 2010–2012

Abstract

ObjectiveTo describe, for the period 2010–2012, the frequency, the causes, the risk factors, the adequacy of care and the avoidability of maternal deaths in France. MethodData from the National Confidential Enquiry into Maternal Deaths for 2010–2012. ResultsFor the period 2010–2012, 256 maternal deaths occurred in France, a maternal mortality ratio of 10.3 per 100,000 live births (95% CI: 9.1–11.7), stable compared to 2007–2009. Compared to women aged 25–29, the risk is multiplied by 2.4 for women aged 35–39, and by 3 for women over 40 years. There are territorial disparities: 1 out of 7 maternal deaths occurs in the French overseas departments, and the maternal mortality ratio in those departments is 4 times that of metropolitan, France; and social disparities: the mortality of migrant women remains 2.5 times higher than that of women born in France, particularly for women born in sub-Saharan Africa whose RMM is 3.5 times that native women. A major finding is the 1/3 decrease in direct maternal mortality over the last 10 years, mainly due to for the first time the statistically significant decrease in mortality from obstetric hemorrhage, the frequency of which was divided by 2 in 10 years. However, almost all of the remaining deaths from hemorrhage are considered preventable and this is still the leading cause of maternal mortality in France (11% of deaths). Overall, 56% of these maternal deaths are considered “avoidable” or “possibly avoidable” and in 59% of cases the care provided was not optimal. ConclusionDirect maternal mortality and in particular maternal mortality from hemorrhage has decreased significantly over the past 10 years, indicating improved obstetric care. However, territorial and social inequalities persist, and the majority of deaths remain preventable, which shows that the identification of opportunities for improvement must continue. To go even further in understanding the mechanisms involved, and to identify precise avenues of prevention, it is necessary to analyze in detail the stories of each maternal death in order to identify the repetitive elements in the series of deaths. This is what the following articles in this issue propose, with an analysis by cause of death, according to the idea that the same cause produces the same effects.