title: Invasive therapies for primary postpartum haemorrhage: a population-based study in France.
abstract: OBJECTIVE
  To describe the characteristics, management, and outcomes of women undergoing invasive therapies for primary postpartum haemorrhage (PPH).
  
  
  METHODS
  A population-based observational study.
  
  
  METHODS
  All 106 maternity units of six French regions.
  
  
  METHODS
  A total of 146 781 women delivering between 2004 and 2006.
  
  
  METHODS
  Prospective identification of women with PPH managed with invasive therapies, including uterine suture, pelvic vessel ligation, arterial embolisation, and hysterectomy.
  
  
  METHODS
  Rate of use and failure rate of invasive therapies, with 95% confidence intervals (95% CIs).
  
  
  RESULTS
  An invasive therapy was used in 296 of 6660 women with PPH (4.4%, 95% CI 4.0-5.0), and in 0.2% of deliveries (95% CI 0.18-0.23). A hysterectomy was performed in 72/6660 women with PPH (1.1%, 95% CI 0.8-1.4%), and in 0.05% of deliveries (95% CI 0.04-0.06). A conservative invasive therapy was used in 262 women, including 183 (70%) who underwent arterial embolisation and 79 (30%) who had conservative surgery as the first-line therapy. Embolisation was more frequently used after vaginal than caesarean delivery, and when arterial embolisation was available on site. The failure rate of conservative invasive therapies was 41/262 (15.6%, 95% CI 11.5-20.6) overall, and was higher after surgical than after embolisation procedures, in particular for vaginal deliveries.
  
  
  CONCLUSIONS
  Both maternal mortality as a result of obstetric haemorrhage and the rate of invasive therapies used for PPH are high in France. These findings suggest flaws in the initial management of PPH and/or the inadequate use of invasive procedures.
  
  
  CONCLUSIONS
  Maternal mortality as a result of haemorrhage and the rate of invasive therapies used for PPH are high in France.
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.|Department of Obstetrics and Gynaecology, APHP, Trousseau Hospital, Université Pierre et Marie Curie, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Kayem
authors.affiliation: Aurore Perinatal Network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Dupont
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: M H
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.affiliation: Aurore Perinatal Network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: R C
authors.initials: RC
authors.lastname: Rudigoz
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Deneux-Tharaux
mesh_terms: D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000401:mortality; D004621:Embolization, Therapeutic / Q000401:mortality* / Q000592:standards; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000401:mortality* / Q000592:standards; D008026:Ligation; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D013537:Sutures
keywords: Embolisation; hysterectomy; maternal mortality; pelvic vessel ligation; postpartum haemorrhage; uterine compression sutures