title: [Epidemiology of maternal mortality by infectious cause in France, 2007-2009, using data from confidential maternal mortality report].
abstract: Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. Over the period 2007-2009, 18 deaths occurred, eight by direct infectious causes and 10 by indirect infectious causes. Among the 18 deaths, 17 were examined by the National Expert Committee on Maternal Mortality (CNEMM) with the objectives to determine the direct or indirect link with pregnancy, the adequacy of care and the preventability of death. Among 8 deaths from direct infectious causes, four deaths were deemed "preventable" or "possibly preventable" because of inadequate care. Among nine deaths from indirect infectious causes, preventability could not be established in two deaths, five were non-preventable and two were preventable due to non-optimal care. These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs.
authors: Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
authors: L
authors: L
authors: Ghesquière
authors: Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; EA4489, environnement périnatal et croissance, faculté de médecine. université Lille 2, 59800 Lille, France. Electronic address: philippe.deruelle@univ-lille2.fr.
authors: P
authors: P
authors: Deruelle
authors: Comité national d'experts sur la mortalité maternelle (CNEMM), 59800 Lille, France.
authors: P
authors: P
authors: Charbonneau
authors: Faculté de médecine, université droit et santé Lille II, Comité national d'experts sur la mortalité maternelle (CNEMM), 59800 Lille, France.
authors: F
authors: F
authors: Puech
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007239:Infections / Q000401:mortality*; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000401:mortality*; D011644:Puerperal Disorders / Q000401:mortality*; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
keywords: Bacteria; Bactérie; Infection; Maternal mortality; Mortalité maternelle; Peripartum; Péri-partum; Virus