Births In France Research Articles

Why women with previous caesarean and eligible for a trial of labour have an elective repeat caesarean delivery? A national study in France.

To identify the characteristics of women and maternity units associated with elective repeat caesarean delivery (ERCD) in women eligible for trial of labour after caesarean (TOLAC). Cross-sectional study. France. Using data from the 2010 French National Perinatal Survey, a representative sample of births in France (n = 14 681 women), we studied two groups of women with prior caesarean section: (i) women eligible for TOLAC according to guidelines (n = 1179) and (ii) a subgroup of these women without any medical characteristics that might indicate ERCD (n = 575). Associations were analysed by multilevel logistic regression. Adjusted odds ratios. Among the 1584 women with a previous caesarean, 1179 (74.4%) were eligible for TOLAC according to guidelines (group 1); 490 (41.6%) had ERCD. Risk of ERCD increased with increasing maternal age and body mass index, pre-existing condition and suspected macrosomia and decreased with previous vaginal deliveries. Among the unit characteristics, private status (aOR = 2.3, 95% CI 1.3-4.1) and low level of care (aOR = 2.5, 95% CI 1.4-4.5]) were independently associated with a higher risk of ERCD after adjustment on patient/pregnancy characteristics. The variability of ERCD rate between hospitals was mainly (78%) explained by the status and level of care, and not (0%) by patient/pregnancy characteristics. Associations with unit characteristics were similar for group 2. For women eligible for TOLAC, the rate of ERCD is high and not in agreement with guidelines. Some characteristics of women are associated with ERCD, but the main determinants are at the unit level, which suggests that non-medical reasons are involved in the decision process. Elective repeat caesarean in women eligible for trial of labour mainly depends on maternity unit characteristics.

New index of social deprivation during pregnancy: results from a national study in France

ObjectivesTo identify precariousness markers in pregnant women that differ from the usual socioeconomic variables.MethodsData were obtained from the National Perinatal Survey, a representative sample of women giving birth in France...

Courbes de croissance in utero ajustées et non ajustées adaptées à la population française. II – Comparaison à des courbes existantes et apport de l’ajustement

Our aim is to compare the new French EPOPé intrauterine growth curves, developed to address the guidelines 2013of the French College of Obstetricians and Gynecologists, with reference curves currently used in France, and to evaluate the consequences of their adjustment for fetal sex and maternal characteristics. Eight intrauterine and birthweight curves, used in France were compared to the EPOPé curves using data from the French Perinatal Survey 2010. The influence of adjustment on the rate of SGA births and the characteristics of these births was analysed. Due to their birthweight values and distribution, the selected intrauterine curves are less suitable for births in France than the new curves. Birthweight curves led to low rates of SGA births from 4.3to 8.5% compared to 10.0% with the EPOPé curves. The adjustment for maternal and fetal characteristics avoids the over-representation of girls among SGA births, and reclassifies 4% of births. Among births reclassified as SGA, the frequency of medical and obstetrical risk factors for growth restriction, smoking (≥10cigarettes/day), and neonatal transfer is higher than among non-SGA births (P<0.01). The EPOPé curves are more suitable for French births than currently used curves, and their adjustment improves the identification of mothers and babies at risk of growth restriction and poor perinatal outcomes.

Initial Preference for Labor Without Neuraxial Analgesia and Actual Use: Results from a National Survey in France.

The rate of neuraxial analgesia during labor in France is one of the highest among high-income countries: 77% of vaginal deliveries in 2010. In this context, the question of how women's preferences for delivering without neuraxial analgesia relate to actual use is of interest. Our objective was to study the factors associated with women's initial preference for labor without neuraxial analgesia and those associated with its use in women who initially preferred not to have it. We used data from the 2010 French National Perinatal Survey, a cross-sectional study of a representative sample of all births in France. Data were collected from interviews with mothers in the postpartum ward and from medical records. Our sample included 7123 women who had vaginal deliveries and were at low risk for cesarean delivery. The factors analyzed were maternal sociodemographic characteristics, prenatal care, childbirth class attendance, labor management, and organization of maternity units. Multilevel Poisson regression models were used to study factors associated with women's initial preference in the overall population and to study factors associated with actual use of neuraxial analgesia in the group of women who initially preferred not to have it. Initially, 26% of our population (n = 1835) preferred to deliver without neuraxial analgesia; this preference was associated with high parity, unfavorable social conditions, and delivery in a public maternity unit. Among these women, 52% (n = 961) delivered with neuraxial analgesia. This discrepancy between initial preference and actual use was significantly associated with nulliparity (adjusted relative risk [aRR] = 1.4; 95% confidence interval [CI], 1.3-1.6), oxytocin augmentation of labor (aRR = 2.4; 95% CI, 2.1-2.7), presence of an anesthesiologist in the unit 24/7 (aRR = 1.4; 95% CI, 1.2-1.6; compared with delivery in hospitals without an anesthesiologist on site 24/7), and high midwife workload (aRR = 1.1; 95% CI, 1.0-1.2). There was no clear association with maternal educational level. Our results suggest that parity, the management of labor, and availability of anesthesiologists play a major role in the intrapartum decision to use neuraxial analgesia for women who initially preferred not to have it. Further research is necessary in the clinical circumstances leading to this decision and the role of women's demands and medical staff attitudes throughout labor.

Proceedings of the fourth international conference on central hypoventilation.

Central hypoventilation syndromes (CHS) are rare diseases of central autonomic respiratory control associated with autonomous nervous dysfunction. Severe central hypoventilation is the hallmark and the most life-threatening feature. CHS is a group of not-fully defined disorders. Congenital CHS (CCHS) (ORPHA661) is clinically and genetically well-characterized, with the disease-causing gene identified in 2003. CCHS presents at birth in most cases, and associated with Hirschsprung’s disease (ORPHA99803) and neural crest tumours in 20% and 5% of cases, respectively. The incidence of CCHS is estimated to be 1 of 200,000 live births in France, yet remains unknown for the rest of the world. In contrast, late-onset CHS includes a group of not yet fully delineated diseases. Overlap with CCHS is likely, as a subset of patients harbours PHOX2B mutations. Another subset of patients present with associated hypothalamic dysfunction. The number of these patients is unknown (less than 60 cases reported worldwide). Treatment of CHS is palliative using advanced techniques of ventilation support during lifetime. Research is ongoing to better understand physiopathological mechanisms and identify potential treatment pathways.The Fourth International Conference on Central Hypoventilation was organised in Warsaw, Poland, April 13–15, 2012, under the patronage of the European Agency for Health and Consumers and Public Health European Agency of European Community. The conference provided a state-of-the-art update of knowledge on all the genetic, molecular, cellular, and clinical aspects of these rare diseases.

What Makes Muslims Feel French?

In this article, we analyze the extent to which Muslims self-identify as French. A common interpretation of Muslim political attitudes assumes that Islam fundamentally conflicts with mainstream European society and that when Muslims are more attached to their religion they will be less likely to identify as French. We examine this assumption by exploring whether Muslim national identification is more strongly related to religiosity or other factors such as socio-economic status, social networks, and immigrant integration. Our results offer some support for each explanation, but we find that religiosity is not the dominant force shaping Muslims' attitudes. Instead, factors associated with immigrant integration have the most profound relationship with Muslim identification. These conclusions are supported by the fact that religiosity and immigrant integration variables have similar effects on the national identification of Christian immigrants. Our findings suggest that focusing on religiosity is not the best way to analyze Muslims' attitudes or identities, and that tensions surrounding Muslims' self-identification with France are likely to decrease in future generations, as immigrant integration proceeds through the increased prevalence of birth in France, having French citizenship, and French language fluency.

EPIPAGE 2: a preterm birth cohort in France in 2011

BackgroundChildren born at low gestational ages face a range of risks and number of neonates surviving very preterm birth is increasing. We present the objectives and methods of a French national cohort of very and moderately preterm children, the EPIPAGE 2 study. It aims to examine short- and long-term outcomes of very preterm children and their determinants.Methods/DesignEligible participants for this prospective population-based study include all infants live born or stillborn and all terminations of pregnancy between 22 and 31 completed weeks of gestation in all the maternity units in 25 French regions. In addition, a sample of moderate preterm births, i.e. births and late terminations at 32–34 weeks, was included in the same regions. In all, 7804 babies (stillbirths and live births) and terminations of pregnancy out of 8400 eligible births in France in 2011 that were either very (22–31 weeks) or moderately preterm (32–34 weeks) were included. Data on pregnancy, delivery, and neonatal events were extracted from the obstetric and neonatal records. The follow-up will collect information at corrected ages of one and 2 years and at 5, 8, and 12 years of age. Of the 4467 children discharged alive from the hospital and eligible for follow-up, 155 (4%) families refused further follow-up and 22 died before one-year of age. Finally, 4290 were included in the follow-up.Eight additional projects investigating specific hypotheses among subsamples of the cohort by collecting specific data in addition to the core cohort data are being conducted to investigate 1) diagnosis of histologic chorioamnionitis, 2) early biomarkers of child health, 3) attitudes of care for extremely preterm infants, 4) painful procedures in neonatal intensive care units, 5) neonatal MRI cerebral abnormalities and their relation to executive functions, 6) associations between early gut colonization and early and late onset diseases, 7) impact of neonatal nutrition on child development, and 8) mother-infant attachment.DiscussionThis project seeks to provide new data on the prognosis and etiology of very preterm birth and to assess related medical practices. Accordingly, it should lead to the development of new strategies of management and prevention in high-risk babies.

Cannabis use during pregnancy in France in 2010

The aim was to estimate the proportion of women who reported cannabis use during pregnancy, to analyse the demographic and social characteristics of users, and the link between cannabis use and either preterm or small-for-gestational-age birth. Data were obtained from interviews of a representative sample of women giving birth in France in 2010 in the days after delivery, and from their medical records. All maternity units in France. The analysis includes women with live singleton births in metropolitan France who responded to the question about cannabis use during pregnancy: in total, 13 545 women. The percentage of cannabis users during pregnancy was estimated, and variations according to social characteristics were described. Logistic regression analyses were used to investigate any associations between cannabis use and preterm birth or small-for-gestational-age status. Percentage of cannabis use, preterm birth rate, and small-for-gestational-age rate. In all, 1.2% of women reported having used cannabis during pregnancy. This percentage was higher among younger women, women living alone, or women who had a low level of education or low income. It was also associated with tobacco use and drinking alcohol. Cannabis users had higher rates of spontaneous preterm births: 6.4 versus 2.8%, for an adjusted odds ratio (aOR) of 2.15 (95% CI 1.10-4.18). The corresponding aOR was 2.64 (95% CI 1.12-6.22) among tobacco smokers and 1.22 (95% CI 0.29-5.06) among non-tobacco smokers. Although the reported rate of cannabis use during pregnancy in France is low, efforts should be continued to inform women and healthcare providers about the potential consequences of its use.

Adult congenital heart diseases

Congenital heart diseases are the most common inborn defects and occur in about 1% of births in France or approximately 7,000 infants per year. Gratefully to the surgery and interventional cardiology advances, up to 90% of children born with congenital heart disease survive and now reach adulthood. Thus the population of adults with congenital heart disease is “booming”, exceeding the infant population with a prevalence of this new population estimated at 3,000 per million in the general population, so more than 150,000 people in France. Most of these patients underwent surgical correction but some have native disease, with a relatively good tolerance up until adulthood. Nevertheless, they are rarely completely cured, and they face problems such as threatening atrial or ventricular arrhythmias, heart failure, endocarditis or pulmonary hypertension. They frequently have residual lesions or sequelae due to the surgical repair. A number of complications, expected or not, and specific issues appear. All this justifies a specialized, long-term follow-up, according the published guidelines.

Le passage transplacentaire des médicaments

With more than 830,000 live births in France, a great number of pregnant women are concerned by a treatment during pregnancy and many questions revolve around appreciating medication-related risks during pregnancy. The human placenta is the interface between mother and fetus and remains difficult to study for ethical reasons. Placental transfer of drugs from mother to fetus is dependent on their physicochemical properties, maternal and fetal factors and placental factors. The human placental perfusion model is the only experimental model to study human placental transfer of drugs in organized placental tissue. In vitro models utilizing cell cultures are mostly limited to the investigation of cellular toxicity along pregnancy or specific transfer mechanisms, such as their interaction with transporters. Taking advantage of the complementarity of these models, it will be possible to develop a rational use of drugs during this period.

Does anonymous sperm donation increase the risk for unions between relatives and the incidence of autosomal recessive diseases due to consanguinity?

In France gamete donation and notably sperm donation are anonymous. It has been claimed that anonymous artificial insemination by donor (AID) could highly contribute to an increase in the level of consanguinity and the incidence of autosomal recessive diseases, due to the unions between offspring of anonymous donors, unaware of their biological kinship, with the special case of unions between half-siblings. The actual incidence of consanguinity due to AID was compared with that resulting from the two other main sources of consanguinity and recessive diseases, i.e. voluntary unions between related individuals or inadvertent unions between the offspring of a common unknown male ancestor (false paternity). From these data, we estimated that expected unions in France between half sibs per year are 0.12 between offspring of sperm donors (1.2 every 10 years) and 0.5 between offspring of common male ancestors through false paternity (5 every 10 years). More generally, the inadvertent unions between false paternity offspring are roughly four times more frequent than those resulting from anonymous AID. We estimated that in the future, when AID has been in practice for several generations, out the 820 000 annual births in France, respectively, 6 and 25 births will be consanguineous through an unknown common ancestor related to anonymous AID and to a false paternity, both of which are negligible when compared with the 1256 children born from first-degree cousins. About 672 children per year are born with a recessive genetic disease due to the panmictic risk and additional affected cases due to consanguinity would be 34.54 for first-cousin offspring, 0.33 for offspring of individuals related due to false paternity and 0.079 for offspring of individuals related due to anonymous AID. Anonymous AID would therefore be responsible for 0.46% of consanguineous births and for 0.01% of recessive diseases. Therefore, the effect of anonymous AID on half-sibling unions, consanguinity and recessive disease incidence can be regarded as marginal.

Syndrome de Lowe révélé par une cataracte congénitale avec anomalies cérébrales de diagnostic anténatal : à propos d’un cas

Congenital cataract is a rare disease whose incidence is estimated to 0.5% of birth in France. A study of the literature shows that congenital cataract is idiopathic in 50% of cases, hereditary forms representing 25% of cases. Other causes of congenital cataract are represented by viral embryofoetopathies acquired during pregnancy, metabolic disorders and chromosomal aberrations within the scope of malformative syndromes. The authors report the case of a neonatal diagnosis of Lowe syndrome suspected by the discovery of bilateral cataract initially isolated. The morphological exploration was completed by secondary brain abnormalities (periventricular lesions). The etiological prenatal exploration was negative. Lowe syndrome is a rare cause of antenatal cataract, which so far only one case has been reported.

What can the UK learn from international comparisons of routinely collected perinatal data? UK perspectives on the Euro-Peristat project

BackgroundClaims that perinatal and infant mortality rates in the UK are higher than those of all comparable countries are often made in a spirit of moral panic, to argue for policies or interventions that may or may not be effective at reducing the rates. Crude perinatal and infant mortality rates tend to be included routinely in successive national and international indicator sets, sometimes being interpreted as measures of population health and sometimes as measures of quality of health care. Such claims inevitably ignore the effect of differences in childbearing populations, data collection methods, and inclusion criteria. The Euro-Peristat project was established to move beyond presentation of unidimensional indicators in isolation and to present data about the outcome of pregnancy for mothers and babies stratified by birthweight and gestational age while presenting comparative data about maternity care and the characteristics of the childbearing population to set them in context. MethodsCollaborators from 26 European Union (EU) member states plus Iceland, Norway, and Switzerland took part in the most recent phase. The indicators were selected with a Delphi process for the first data collection for the year 2000 and revised to compile data for 2004 and then 2010. They were designed to be compiled from routine national vital registration, clinical, or administrative data collection systems in the form of cross-tabulations of aggregated anonymised data. Each country provided information about methods of data collection and inclusion criteria. No rankings were applied and the countries were listed alphabetically according to their official EU names. Data were published in the form of graphs of indicators and tables of data. Stillbirth and neonatal mortality rates were calculated with WHO definitions. Where possible, indicators of outcome were constructed with common cutoffs on the basis of gestational age or birthweight, to avoid bias towards higher reported rates in countries in which births and deaths are registered at lower gestational ages. FindingsAll indicators showed wide variation between countries, although some of this variation could be attributed to differences in data collection and ascertainment. Because of differences in data collection, data for the countries of the UK were compiled separately. Stillbirth rates at or after 28 weeks of gestation ranged from 1·5 per 1000 total births in the Czech Republic to 4·3 per 1000 total births in France, with rates of 3·8 per 1000 total births in England and Wales, 3·6 per 1000 total births in Scotland, and 3·4 per 1000 total births in Northern Ireland being among the higher rates. Neonatal mortality rates at 24 weeks or more of gestation ranged from 0·8 per 1000 livebirths in Iceland and 1·1 per 1000 livebirths in Finland to 4·3 per 1000 livebirths in Romania, with rates of 2·0 per 1000 livebirths in England and Wales, 2·1 per 1000 livebirths in Scotland, and 3·0 per 1000 livebirths in Northern Ireland. Rates for some countries were based on small numbers of events. There were also differences in risk factors. InterpretationThe interpretation of these and other indicators are discussed more fully in the first and second European Perinatal Health Report. Infant and perinatal mortality rates in the UK were not the highest in Europe but they were above the median. To be useful for identification of scope for improvements, international comparisons of the outcome of pregnancy should take account of random variation and differences in methods of data collection and population characteristics. Simple league tables based on crude rates are unhelpful. FundingEuro-Peristat is funded by the Health Programme of the European Commission's Directorate General for Health and Consumers. The funding source had no role in the writing of this abstract or the reports on which it is based.

Prevalence of toxoplasmosis in France in 1998: Is there a difference between men and women? At what age do children become infected?

BackgroundThe only national seroprevalence data currently available on toxoplasmosis in France are from the national perinatal surveys of pregnant women conducted in 1995 and 2003. These surveys are national, exhaustive and cross-sectional studies of all pregnant women who give birth in France during one specified week. These cross-sectional studies, conducted among women of childbearing age (defined as 18 to 45 years), showed a positive correlation between seroprevalence and age, with a significant regional disparity. This study was performed in order to compare the prevalence of toxoplasmosis antibodies in men and women in the 18–45 age group, to confirm regional variations and to estimate the seroprevalence of toxoplasmosis in France for different age groups, particularly among children and among adults aged over 45 years. MethodsSerum samples from 2060 subjects were available from a national serum bank that was established in 1997 as part of a European study on vaccine preventable diseases. The sera were tested for IgG antibodies in 2008–2009, by ELISA test, at the laboratory of parasitology-mycology, CHU Grenoble. ResultsThe seroprevalence for the population aged 1–64 years was 55.4%. Seroprevalence did not vary between the sexes, except among those aged over 45 years, where it was higher in men than in women. Toxoplasmosis seroprevalence varied significantly by regions for all ages. It increased with age and we noted a stronger increase in prevalence in adolescents (10–20 years) than in other age groups. ConclusionThis study showed that children have limited exposure to Toxoplasma gondii and that seroprevalence in men and women does not differ for the population aged 45 years and under. This study confirms the geographical disparity in prevalence in France that has been found in other studies in women of childbearing age. This disparity cannot be explained by different laboratory techniques, because sera were tested in a single laboratory. The study also raises the possibility of extrapolating seroprevalences from ENP to the general population and thus estimating the seroprevalence in the French population.

Le rétinoblastome : état des lieux au Mali et programme d’aide au diagnostic précoce, aux traitements et à la réhabilitation

Retinoblastoma (RB) is a rare embryonic tumour that represents 1/16,000 births in France. In Mali, a study showed the characteristics of a hospital series of cases seen in Bamako in the Pediatric Oncology Unit of Gabriel Touré Teaching Hospital and in the Tropical Ophthalmology Institute of Africa (IOTA) between January 2005 and June 2007. Median age was 4 years versus 2 years in France for unilateral disease. Near two third of children with RB had extra-ocular extension at diagnosis, which is now exceptional in France. Only 11% were bilateral versus 35% in France. Cure rate was around 50%, but it is estimated only on the cases arriving in Bamako and with at least 20% lost of follow-up. Cure rate is over 95% in France within an exhaustive register. RB appears as an exemplary tumor and rapid improvements could be obtained in low-income countries with relatively limited means. This is why, the Alliance mondiale contre le cancer (AMCC), the Institut Curie in Paris, which is the reference center in France for RB, and teams in Bamako were proposing a program to help the development of early diagnosis, treatments, including eye preservation, and rehabilitation of children with RB in sub-Saharan Africa in collaboration with the Groupe franco-africain d’oncologie pédiatrique (GFAOP). The official launching of this program was held in Bamako November 4th, 2011 for Mali and the surrounding regions. After this first experience, this program is now implemented in other countries.

Accidental out‐of‐hospital deliveries: a case–control study

To determine risk factors for accidental out-of-hospital deliveries (OHDs), which represent 0.5% of live births in France and are associated with poor neonatal outcomes. This retrospective case-control study assessed accidental OHDs that occurred in the Finistère District (Brittany, France) between January 2007 and December 2009. For each OHD case, two controls were randomly selected. Outcome measures included maternal demographics, obstetric characteristics and neonatal outcomes. During the study period, accidental OHDs accounted for 0.42% of all births; 76 accidental OHDs were included in the analysis. Multivariate analysis found four independent risk factors for accidental OHD: multiparity [OR: 8.84 (3.22-24.29)], unemployment [OR: 4.99 (1.85-13.47)], lack of or poor antenatal care [OR: 9.00 (2.41-33.72)] and a travel time >45 min from home to the delivery unit [OR: 6.18 (1.33-28.65) versus < 15 min]. Significantly more newborns from the OHD group required admission to the neonatal unit (p = 0.04), but accidental OHD was not significantly associated with prematurity or low birth weight. Four risk factors for accidental OHD were identified. Setting up an anonymous registry of OHD cases could improve our knowledge and screening of women at risk.

Le portrait des mères néonaticides dans les expertises judiciaires

Neonaticide is the term used to refer to the killing of newborn infants within the first 24 hours of life. A recent study conducted by Inserm Unit 750 found a frequency of 2.1 cases of neonaticide for 100,000 births in France. The persistence of these crimes raises serious issues, and scientists have attempted to explain this by the profile of neonaticidal mothers: young, or even teenage, single, primiparous, and socially deprived. The present study sought to question this profile, and to suggest a new profile for neonaticidal mothers. This retrospective study over the years 1996-2000 comprised 32 cases of neonaticide perpetrated in three French regions. Seventeen solved cases of these 32 cases generated 54 documents by expert consultants, mainly psychiatric and psychological expertise, studied and analysed here using Modalisa software for quantitative analyses and Nvivo software for qualitative data. No single socio-demographic profile was observed. The mothers were in contrasting situations at the time of the event. There were few psychotic profiles. The other psychopathological disturbances detected were very often related to the event. The most surprising feature in the expert reports describing the neonaticidal mothers was the existence of what we have termed "descriptive absent-factors". These mothers had not experienced major trauma in childhood such as the death of persons close or foster care. They were not living in an environment of family violence. They did not exhibit addictive or self-harm behaviour. Their parents before them had similar profiles, except three cases of alcoholism. Their parentage, and that of the infants, was not an issue. The most widely described personality features were immaturity, dependency on others, withdrawal, inhibition, emptiness, lack of affectivity, non-expressiveness, and devaluation of self-image. The very impoverished relational environment of these mothers also appears in the expertise data. Their affective and relational foundations were insecure. The "classic" profile of the neonaticidal mother as being young, single, and primiparous is not confirmed in this study. Recent American and European studies reach similar conclusions. More than half of these mothers already had other children; more than half were living with a partner. Nor did these mothers have an evident psychopathological profile, and even less so a psychopathic profile. This study suggests a "psycho-relational" profile for the neonaticidal mother: immature, affectively dependent, expressing herself very little, and experiencing considerable affective isolation. These neonaticidal mothers did not present any specific socio-demographic or evident psychopathological profile. The study nevertheless enabled definition of a "psycho-relational" profile.

Organisation des soins en analgésie, anesthésie et réanimation en maternité en France métropolitaine : résultats comparés des enquêtes nationales périnatales 2003 et 2010

ObjectiveThe equipment and practices in obstetric analgesia, anaesthesia and intensive care, as well as their evolution between 2003 and 2010 in metropolitan France, were described. Population and methodsData were derived from two representative samples of births in 2003 and 2010, based on all births in France during one week. The sample included 534 maternity units and 14,903 births in 2010 and 618 maternity units and 14,737 births in 2003. ResultsThe caesarean operating room was adjacent or inside the labour ward in 66% of maternity units in 2010 vs 56% in 2003. An anaesthetist was appointed permanently to the labour ward in 38.9% of maternity units in 2010 vs 21.5% in 2003. Locoregional analgesia or anaesthesia rate increased significantly: 81.5% in 2010 compared to 74.9% in 2003. Almost all operative vaginal deliveries were performed under epidural anesthesia in 2010. Patient controlled epidural analgesia (PCEA) was available in 58% of the units in 2010 but only 34.2% of women had PCEA. Newborn's resuscitations were performed mainly by paediatricians in 2010, but 11.4% of children were resuscitated by an anaesthetist in level 1 maternity units. ConclusionThe conditions required to ensure anaesthetic care safety in maternity units has improved since 2003. Improvements in quality of care are still possible.

Advantages and limitations of using national administrative data on obstetric blood transfusions to estimate the frequency of obstetric hemorrhages

Obstetric hemorrhages are a frequent cause of maternal death all over the world, but are not routinely monitored. Health systems administrative databases could be used for this purpose, but data quality needs to be assessed. Using blood transfusion data recorded in administrative databases to estimate the frequency of obstetric hemorrhages. Research design A population-based study. Subjects Validation sub-sample: all mothers who gave birth in a French region in 2006-07 (35 123 pregnancies). Main study: all mothers who gave birth in France in 2006-07 (1 629 537 pregnancies). Linkage and comparison of administrative data on blood transfusions with data from the French blood agency ('gold standard'), and, based on this validation, the construction of a multivariable regression model to correct the number of pregnant women identified as having received a transfusion in the national administrative database. The blood transfusion rate observed in the gold standard was 7.12‰. The sensitivity of the administrative data was estimated at 66.3% and the positive predictive value at 91.3%. The estimated total number of pregnant women who received blood transfusions in France in 2006-07 was 10 941 (6.71‰). The administrative data, available in most countries, can be used to estimate the frequency of obstetric hemorrhages.

Trends in perinatal health in France from 1995 to 2010. Results from the French National Perinatal Surveys

To study trends in the main indicators of health, medical practices and risk factors in France. We collected data from samples of all births in France during one week in 1995 (n=13318), 1998 (n=13718), 2003 (n=14737) and 2010 (n=14903) and have compared them. Between 1995 and 2010, maternal age and body mass index increased steadily, but tobacco use decreased. In 2010, 39.4% of pregnant women had a visit with a midwife in a maternity unit, versus 26.6% in 2003. Deliveries occurred in large public hospitals more and more frequently. The increase in caesarean sections was no longer significant between 2003 and 2010. In general, medical decisions during pregnancy and delivery were closer to professional recommendations in 2010 than in earlier years. Live births before 37 weeks increased steadily from 5.4% in 1995 to 6.6% in 2010, but the proportion of birth weights below 2500g or the 10th percentile stopped increasing after 2003. Routine national perinatal surveys highlight major trends in maternal characteristics, obstetric practices, organisation of services, and perinatal health.