[Prevention and early management of immediate postpartum haemorrhage: policies in six perinatal networks in France].
OBJECTIVE
Postpartum haemorrhage (PPH) constitutes the leading cause of maternal deaths in France, and the majority of these deaths are preventable. The objective of this study was to ascertain policies for prevention and early management of PPH in maternity units, and to compare the results with scientific evidence. The survey was part of the Euphrates European project, and was conducted in France in 2003 before national recommendations for clinical practice related to PPH were launched.


METHODS
A cross-sectional declarative survey was conducted in six perinatal networks representing 132 maternity units. A postal questionnaire was sent to all units. Main outcomes measured were stated policies for prevention, diagnosis and management of PPH.


RESULTS
There was no definition of PPH in one out of four units, and no written protocol for PPH management in one out of six. Policies of using preventive uterotonics were widespread, but variation was observed concerning the timing of administration, and association with the other components of active management of the third stage of labour. Policies about drugs used for management of PPH also varied.


CONCLUSIONS
Variations in policies show firstly that evidence-based improvement in practice is possible, and secondly that further research is needed on poorly documented aspects of PPH management.
Deneux-Tharaux
C
C
Recherches épidémiologiques en santé périnatale et santé des femmes, Inserm U149, IFR 69, bâtiment recherche, hôpital Tenon, université Pierre-et-Marie-Curie-Paris-6, 4, rue de la Chine, 75020 Paris, France. cdeneux.u149@chusa.jussieu.fr
Dreyfus
M
M
Goffinet
F
F
Lansac
J
J
Lemery
D
D
Parant
O
O
Chauveaud
A
A
Bréart
G
G
Bouvier-Colle
M-H
MH
D002985:Clinical Protocols; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006757:Hospital Units; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011795:Surveys and Questionnaires