title: [Severe post-partum hemorrhage: descriptive study at the Robert-Debré Hospital maternity ward].
abstract: OBJECTIVE
  To analyze the prevalence, cause, treatment, and risk factors of severe post-partum hemorrhage (transfusion, surgery, radiology) observed at the maternity ward of the Robert-Debré Hospital, Paris. Method. This retrospective cohort was collected from a database including 19182 deliveries from 1992 to 1998. The entire medical file was reviewed in cases of severe hemorrhage.
  
  
  RESULTS
  The prevalence of severe post-partum hemorrhage was 23 per 10,000 deliveries (44 patients). Transfusion was performed in 44/44 and hysterectomy in 3/44. Three patients were transferred to the intensive care unit. There were no deaths. At multivariate analysis, risk factors for severe post-partum hemorrhage were: abnormal placental insertion (OR=7.2; 95CI: 2.18-18.3), cesarean (OR=5.8; 95CI: 2.9-11.6), multiple pregnancy (OR=3.2; 95CI: 1.3-7.8), prematurity (OR=3, 95CI: 1.5-6.2), hypertension (OR=2.9; 95CI: 1.3-6.3). Twenty-six percent of the patients had no risk factors.
  
  
  CONCLUSIONS
  The prevalence of severe pot-partum hemorrhage is low in our experience. The methodology used for this retrospective cohort does not enable an explanation. Intensive obstetrical care is necessary in case of abnormal placenta insertion. In 10 out of 44 cases, severe post-partum hemorrhage occurred in a context of insufficient monitoring, late or erroneous diagnosis, or incorrect treatment.
authors.affiliation: Service de Gynécologie Obstétrique, Département d'Anesthésie Réanimation, Hôpital Robert-Debré, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Reyal
authors.forename: J
authors.initials: J
authors.lastname: Deffarges
authors.forename: D
authors.initials: D
authors.lastname: Luton
authors.forename: P
authors.initials: P
authors.lastname: Blot
authors.forename: J F
authors.initials: JF
authors.lastname: Oury
authors.forename: O
authors.initials: O
authors.lastname: Sibony
mesh_terms: D000704:Analysis of Variance; D001803:Blood Transfusion; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007044:Hysterectomy; D010922:Placenta Diseases / Q000150:complications; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D012307:Risk Factors
vernacular_title: Hémorragie grave du post-partum. Etude descriptive à la maternitè de l'hôpital Robert-Debré.