Republication de : Mortalité Maternelle, Fréquence, causes, profil des femmes et évitabilité des décès en France 2013–2015

Abstract

ObjectiveTo describe, for the 2013–2015 period, the frequency, causes, risk factors, adequacy of care and preventability of maternal deaths in France. MethodData from the National Confidential Enquiry into Maternal Deaths for 2013–2015. ResultsFor the period 2013–2015, 262 maternal deaths occurred in France, one every four days, i.e., a maternal mortality ratio of 10.8 per 100,000 live births (95 % CI 9.5–12.1), stable compared to 2010–2012. Compared to women aged 25–29, the risk is multiplied by 1.9 for women aged 30–34, by 3 for women aged 35–39 and by 4 for women aged 40 and over. Obese women are twice as frequent among maternal deaths (24 %) than in the general population of parturients (11 %). There are territorial disparities — the maternal mortality ratio in the French overseas departments is 4 times higher than in metropolitan France —, and social disparities — the mortality of migrant women remains higher than that of women born in France, particularly for women born in sub-Saharan Africa whose risk is 2.5 times higher than that native women. A striking result of the 2013–2015 period is the preponderance of suicides and cardiovascular diseases, the two leading causes of maternal mortality, each responsible for approximately one death per month. These two aetiologies are not only the most frequent, but also among those with the highest proportion of preventable deaths, 91.3 % and 65.7 % respectively. Another important result is the continued decrease in mortality from obstetric haemorrhage, halved in 15 years, particularly the decrease in haemorrhages due to uterine atony. Overall, 57.8 % of maternal deaths are considered probably or possibly preventable and in 66 % of cases, the care provided was not optimal. ConclusionWhile the overall maternal mortality ratio remains stable overall, and territorial and social inequalities unchanged, the profile of the causes of maternal mortality is changing. Some developments are a success, such as the continued decrease in maternal mortality due to haemorrhage, the result of the general mobilisation of health actors on this issue. Others point to new priorities for mobilisation, in particular on the mental and cardiovascular health of women during pregnancy or in the year following childbirth. In order to go further in understanding the mechanisms involved, and to identify precise avenues for prevention, it is necessary to analyse in detail the stories of each maternal death in order to identify the opportunities for improvement repeatedly found in the series of deaths. This is what the following articles in this issue propose, with an analysis by cause of death.