[Frequency, causes and risk factors of postpartum haemorrhage: a population-based study in 106 French maternity units]

Abstract

Objective: To estimate the incidence, to describe the aetiology and to identify the risk factors of postpartum haemorrhage (PPH).

Material and method: Prospective study conducted in 106 French maternity units of six perinatal networks between December 2004 and November 2006. PPH was defined by a blood loss superior to 500 mL or necessitating an examination of the uterus, or a peripartum haemoglobin drop superior to 2 g/dL. Severe PPH was defined by at least one of these criteria : peripartum haemoglobin drop superior or equal to 4 g/dL, embolization, conservative surgical procedure, hysterectomy, transfusion, transfer to intensive care or death.

Results: The incidence of PPH was 6.4% [CI 95% 6.3-6.5] with variations between maternity units from 1.5% to 22.0%; incidence of severe PPH was 1.7% [CI 95% 1.6-1.8] with variations between units from 0% to 4%. Atony was the main aetiology of PPH, whatever the mode of delivery and severity. The risk factors identified were those classically described in the literature.

Conclusion: In these six French perinatal networks, in 2005-2006, the PPH profile was characterized by an incidence of severe forms higher than previous population-based estimates from other countries. This suggests a more frequent aggravation of PPH and the implication of inadequate PPH management.

Keywords: Aetiology; Facteurs de risque; Hémorragie du post-partum; Incidence; Postpartum haemorrhage; Risk factors; Étiologie.