Abstract
ObjectiveMaternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries.MethodsUsing data between 2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N = 6,660 PPH) and Canada (N = 9,838 PPH). We assessed factors associated with PPH through multivariate logistic models.ResultsPPH incidence, overall (4.8% (95% CI 4.7–4.9) in Canada and 4.5% (95% CI 4.4–4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2–5.4) in Canada and 4.8 (95%CI 4.7–4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23–1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery.ConclusionPPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH.
Highlights
Postpartum haemorrhage (PPH) remains a major cause of maternal death worldwide [1,2,3], but the maternal mortality ratio due to PPH -defined as the number of maternal deaths due to PPH divided by the total number of live births- differs between countries
All medical diagnoses were abstracted from the medical charts by clinicians and were coded, for the period of interest, using the International Classification of Diseases (ICD-10); procedures were coded using the Canadian Classification of Interventions (CCI), supplemented by information routinely collected in the DAD
Studied Variables We examined the characteristics of women, pregnancy, labour, and delivery that had previously been identified as PPH risk factors [11,12,13]: maternal age (,20 years, 20–24, 25–34, and $35), parity and previous caesarean delivery combined
Summary
Postpartum haemorrhage (PPH) remains a major cause of maternal death worldwide [1,2,3], but the maternal mortality ratio due to PPH -defined as the number of maternal deaths due to PPH divided by the total number of live births- differs between countries. In France, this ratio is higher than in other developed countries with comparable national surveillance systems of maternal mortality. In 2004–2006, PPH accounted for 1.40 maternal deaths per 100,000 live births in France [3], compared with 0.66 per 100,000 live births in the United Kingdom [4] and 0.25 per 100,000 live births in Canada (1999–2004) [5]. As death due to PPH is considered largely preventable [3], it is important to understand the reasons for the higher maternal mortality ratio in France. Canada and France have a similar level of resources, and available databases make direct comparisons of PPH features between these two countries possible
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