Maternal deaths and substandard care: the results of a confidential survey in France. Medical Experts Committee.
OBJECTIVE
Confidential enquiries were carried out to attempt to understand why the level of maternal mortality has been high in France.


METHODS
A descriptive retrospective survey has been carried out. Five administrative regions participated in the survey. All maternal deaths--according to the WHO definition--that occurred in these regions over a period of at least 1 year were studied. A specialist completed a full medical questionnaire for each death. Then a committee of medical experts determined the reasons for the death and whether it might have been avoided.


RESULTS
Forty-six deaths were recorded, 39 of which were classified as maternal. Haemorrhages were the leading underlying cause, then embolism and hypertensive diseases. Of the 39 deaths, 17 were determined to have been certainly avoidable, and nine more probably avoidable. More than half of all maternal deaths were related to inappropriate or substandard care. These results are discussed in the light of the British and Dutch experience with confidential enquiries into maternal deaths.


CONCLUSIONS
There is no clear explanation why the French maternal mortality rate is high, but the study points out some malfunctions in health care service.
Bouvier-Colle
M H
MH
l'Institut national de la Santé et de la recherche médicale (INSERM), Unité 149, Recherches épidémiologiques sur la santé des femmes et des enfants, Paris, France.
Varnoux
N
N
Bréart
G
G
D003219:Confidentiality; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008428:Maternal Mortality; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000401:mortality; D014944:World Health Organization