title: Invasive therapies for primary post-partum haemorrhage as missed opportunities for medical prevention.
abstract: OBJECTIVE
  Examine the available results from population-based studies to test the hypothesis that differences between countries in medical practices for the management of labour, delivery and early bleeding may lead to a differential risk of post-partum haemorrhage (PPH)-related maternal morbidity and in the need for PPH-related invasive therapies.
  
  
  RESULTS
  International comparison of ratios of maternal mortality due to PPH shows significant differences between developed countries. Direct international comparisons of PPH rates to investigate these differences are difficult because PPH definition is not homogeneous. One widely used proxy for severe PPH is the use of secondary invasive procedures for PPH treatment. Comparative analysis of results from population-based studies shows wide variations in the rates of invasive therapies for PPH across countries and suggests that high rates of such therapies may be explained partly by variations in practices for the management of first and third stages of labour and in the noninvasive steps of PPH treatment.
  
  
  CONCLUSIONS
  Invasive therapies for PPH may be considered markers of missed opportunities for primary or secondary prevention of PPH. Management of first and third stages of labour as well as the early steps of PPH treatment are important keys to prevent severe maternal complications of PPH and the need for invasive therapies.
authors.affiliation: aInserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes UniversitybDepartment of Obstetrics and Gynecology, Trousseau Hospital, APHP, Université Pierre et Marie Curie, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
mesh_terms: D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007749:Labor Stage, Third; D007743:Labor, Obstetric; D008428:Maternal Mortality; D009426:Netherlands / Q000453:epidemiology; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011312:Pressure; D013536:Suture Techniques / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data; D014599:Uterus / Q000601:surgery*
chemical_list: D010120:Oxytocics; D010121:Oxytocin