title: Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions.
abstract: OBJECTIVE
  To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage.
  
  
  METHODS
  Retrospective questionnaire survey.
  
  
  METHODS
  Three administrative regions of France.
  
  
  METHODS
  All women who were pregnant or had recently given birth during the year before the survey.
  
  
  METHODS
  A European survey (MOMS-B) defined severe haemorrhages as blood loss > or = 1500mL. A specific questionnaire was added in France to analyse the quality of care of these haemorrhages. The survey was carried out in three different administrative regions: Champagne-Ardenne, the Centre and Lorraine. An expert committee was appointed and began by establishing a framework for qualitative assessment. One hundred and sixty-five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and 'mixed' care were both considered substandard. The 165 cases were coded and then studied with uni- and multivariate analysis (logistic regression with SAS and SPSS software).
  
  
  RESULTS
  Of the 165 cases identified, 51% (85/165) were vaginal, 19% (31/165) operative vaginal, and 30% (49/165) caesarean. The leading cause of haemorrhage was uterine atony. Overall, 62% of the cases received appropriate care, 24% received totally inadequate care and 14% mixed care. After adjustment for sociodemographic factors, antenatal care and organisational aspects, the lack of a 24-hour on-site anaesthetist at the hospital and a low volume of deliveries (<500 births per year) were the factors associated with substandard care.
  
  
  CONCLUSIONS
  Organisational features are so important that application of good clinical practices for safer motherhood reinforce the need for new organisation of obstetric services. For the first time, the presence of an anaesthetist is shown to have a measurable effect on the quality of care for women giving birth. These results need to be confirmed by others.
authors.affiliation: Epidemiological Research Unit on Perinatal and Women's Health INSERM, National Institute of Health and Medical Research, Paris, France.
authors.forename: M H
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.forename: D
authors.initials: D
authors.lastname: Ould El Joud
authors.forename: N
authors.initials: N
authors.lastname: Varnoux
authors.forename: F
authors.initials: F
authors.lastname: Goffinet
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: F
authors.initials: F
authors.lastname: Bayoumeu
authors.forename: E
authors.initials: E
authors.lastname: Beaumont
authors.forename: H
authors.initials: H
authors.lastname: Fernandez
authors.forename: J
authors.initials: J
authors.lastname: Lansac
authors.forename: G
authors.initials: G
authors.lastname: Lévy
authors.forename: M
authors.initials: M
authors.lastname: Palot
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006276:Health Facility Size; D006801:Humans; D017533:Marital Status; D008428:Maternal Mortality; D015999:Multivariate Analysis; D009774:Obstetrics / Q000592:standards*; D011181:Postnatal Care / Q000458:organization & administration / Q000592:standards*; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000628:therapy*; D011247:Pregnancy; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*; D012189:Retrospective Studies