[Declarative survey about postpartum haemorrhage management by anaesthesiologists in Pays de la Loire area (France): what's the adherence to clinical practice guidelines?].
OBJECTIVE
To assess the management of postpartum hemorrhage (PPH) by anaesthesiologists in Pays de la Loire area.


METHODS
A declarative survey was conducted from November 2011 to January 2012 with an online questionnaire to assess prevention and PPH specific care and to clarify the PPH transfusion practices and interest of new therapies. Nine indicators of adherence to clinical practice guidelines were selected to distinguish two groups: one group "adhering to the RCP" and another "not adhering to the RCP".


RESULTS
Response rate 53%. One hundred and one responses were analyzed. Use of a collection bag graded blood receipt pockets 93%, start time of PPH noted: 76%, leaf specific monitoring: 67%, management of the third part of the work: 78%. The evacuation of the placenta is performed within 30minutes in 75% of cases. The transfusion strategy happens early (92% before the biological assessment results) and "aggressive" (ratio RCB/FFP is 1/1 for 72%). The use of tranexamic acid is not systematic (53%). Seventy-nine percent of respondents adhere to the RCP. Practitioners in maternity level 1 (with few deliveries) don't follow these RCP as much.


CONCLUSIONS
Some inappropriate practices remain in structures not used to support them. The use of new therapies remain controversial. The priority at this time is the implementation and enforcement of the current RCP, not their modifications.
Pôle d'anesthésie-réanimation, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers, France. Electronic address: clement.bouvet@gmail.com.
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Bouvet
Pôle d'anesthésie-réanimation, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers, France.
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Lehousse
Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49033 Angers cedex 1, France.
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Sentilhes
Réseau de santé en périnatalité « sécurité naissance - naître ensemble » des Pays de la Loire (RSN), 2, rue de la Loire, 44200 Nantes, France.
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Branger
Pôle d'anesthésie-réanimation, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers, France.
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Granry
D000328:Adult; D000776:Anesthesiology / Q000639:trends*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D020407:Internet; D010820:Physicians; D006473:Postpartum Hemorrhage / Q000628:therapy*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014148:Tranexamic Acid / Q000627:therapeutic use
D006490:Hemostatics; D014148:Tranexamic Acid
Anesthesia; Anesthésie; Care; Hemorrhage; Hémorragie; Maternal mortality; Mortalité maternelle; Pays de la Loire; Post-partum; Postpartum; Prise en charge