title: Postpartum haemorrhage in Canada and France: a population-based comparison.
abstract: OBJECTIVE
  Maternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries.
  
  
  METHODS
  Using data between 2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N = 6,660 PPH) and Canada (N = 9,838 PPH). We assessed factors associated with PPH through multivariate logistic models.
  
  
  RESULTS
  PPH incidence, overall (4.8% (95% CI 4.7-4.9) in Canada and 4.5% (95% CI 4.4-4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2-5.4) in Canada and 4.8 (95%CI 4.7-4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23-1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery.
  
  
  CONCLUSIONS
  PPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH.
authors.affiliation: INSERM, U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France. marie-pierre.bonnet@inserm.fr
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Bonnet
authors.forename: Olga
authors.initials: O
authors.lastname: Basso
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.forename: Corinne
authors.initials: C
authors.lastname: Dupont
authors.forename: René-Charles
authors.initials: RC
authors.lastname: Rudigoz
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fuhrer
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
mesh_terms: D002170:Canada / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D011247:Pregnancy; D011859:Radiography; D012307:Risk Factors