title: Policies for management of postpartum haemorrhage: the HERA cross-sectional study in France.
abstract: OBJECTIVE
  The principal objective of this study was to describe the policies reported by French maternity units for the prevention and early management of postpartum haemorrhage (PPH). The second objective was to assess their variation according to hospital level and status.
  
  
  METHODS
  Cross-sectional observational study of French maternity units, from January 2010 to April 2011. The medical supervisor (obstetrician or midwife) of participating maternity wards completed a questionnaire designed to ascertain the unit's protocol for preventing and managing PPH after both vaginal and caesarean deliveries at a gestational age >22 weeks (or a birth weight >500g). The main outcome measure was the percentage of units reporting protocols adhering to the principal criteria for adequate management defined by the 2004 French guidelines for PPH.
  
  
  RESULTS
  252 maternity units participated in the survey. Almost all units had a written protocol for PPH (97.2%). For vaginal deliveries, 82.5% of units had a definition of PPH (>500ml) and 92.8% had a policy of preventive oxytocin use. For caesareans, only 23.8% defined PPH (as >1000ml), 68.8% used manual delivery of the placenta, and 76.9% recommended oxytocin injection immediately after the birth. The first-line medication for PPH was oxytocin (96.3%) and the second-line treatment a prostaglandin (97.5%). Level III maternity units had a definition of haemorrhage for vaginal deliveries more often than did other levels of care (P=0.04). Manual removal of the placenta after caesareans was significantly more frequent in level I than level III units (P=0.008) and in private than other types of maternity units. Medical management of haemorrhage did not differ according to level of care or maternity status.
  
  
  CONCLUSIONS
  The responses by maternity unit supervisors showed significant improvement in the management of PPH accordingly to the 2004 French guidelines, especially for the third stage of labour. This improvement did not differ between hospitals by levels of care or legal status.
authors: Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de médecine RTH Laennec, Lyon, France. Electronic address: fvendittelli@chu-clermontferrand.fr.
authors: Françoise
authors: F
authors: Vendittelli
authors: Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France.
authors: Chloé
authors: C
authors: Barasinski
authors: Direction de la Recherche clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors: Bruno
authors: B
authors: Pereira
authors: Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, France; Université de Caen, Caen, France.
authors: Michel
authors: M
authors: Dreyfus
authors: Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de médecine RTH Laennec, Lyon, France.
authors: Didier
authors: D
authors: Lémery
authors: Inserm, U 1153, Equipe Epopè, CRESS, Université Paris Descartes 5, Paris, France.
authors: Marie-Hélène
authors: MH
authors: Bouvier-Colle
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D019468:Disease Management; D005260:Female; D005602:France; D006801:Humans; D006473:Postpartum Hemorrhage / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy
keywords: Caesareans; Delivery; Immediate postpartum haemorrhage; Third stage of labour