Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study.

Objective: Obesity has significant implications for the health of pregnant women. However, few studies have quantified its association with maternal mortality or examined the relevant underlying causes and the role of care, although this remains the most severe maternal outcome. Our objectives were to quantify the risk of maternal death by prepregnancy body mass index and to determine whether obesity affected the quality of care of the women who died.

A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care.

Objective: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments.

Methods: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care.

Delivery Hospital Characteristics and Postpartum Maternal Mortality: A National Case-Control Study in France.

Background: The variability in resources for managing critical events among maternity hospitals may impact maternal safety. Our main objective was to assess the risk of postpartum maternal death according to hospitals' organizational characteristics. A secondary objective aimed to assess the specific risk of death due to postpartum hemorrhage (PPH).

Risk of severe maternal morbidity associated with in vitro fertilisation: a population-based study.

Objective: To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor.

Design: Population-based cohort-nested case-control study.

Setting: Six French regions in 2012/13.

[Maternal mortality among women with Marfan syndrome or vascular Ehlers-Danlos syndrome in France, 2001-2012].

Objective: To describe maternal deaths in France associated with Marfan's syndrome or vascular Ehlers-Danlos syndrome.

Study Design: A retrospective descriptive study based on data from the national confidential enquiry into maternal deaths, in France, during 2001-2012. Characteristics of the patients, their pregnancies and details of their deaths were analysed.

Maternal Death Due to Amniotic Fluid Embolism: A National Study in France.

Background: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria.

Methods: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39).

Policies for management of postpartum haemorrhage: the HERA cross-sectional study in France.

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.

Study Design: Cross-sectional observational study of French maternity units, from January 2010 to April 2011.

Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil.

Background: Cesarean delivery rates continue to increase worldwide and reached 57% in Brazil in 2014. Although the safety of this surgery has improved in the last decades, this trend is a concern because it carries potential risks to women's health and may be a modifiable risk factor of maternal mortality. This paper aims to investigate the risk of postpartum maternal death directly associated with cesarean delivery in comparison to vaginal delivery in Brazil.

Duration of Expulsive Efforts and Risk of Postpartum Hemorrhage in Nulliparous Women: A Population-Based Study.

Objective: To assess the specific association between the duration of expulsive efforts and the risk of postpartum hemorrhage.

Methods: Population-based cohort-nested case-control study of nulliparous women delivering vaginally in 106 French maternity units between December 2004 and November 2006, including 3,852 women with PPH (blood loss ≥ 500 mL and/or peripartum Hb decrease ≥ 2 g/dL), 1,048 of them severe (peripartum Hb decrease ≥ 4 g/dL or transfusion of ≥ 2 units of red blood cells), and 762 controls from a representative sample of deliveries without hemorrhage in the same population. The association between duration of expulsive efforts and postpartum hemorrhage was estimated by multilevel logistic regression models adjusted for individual and hospital characteristics.

Maternal mortality among women with sickle-cell disease in France, 1996-2009.

Objective: To describe maternal mortality among women with sickle-cell disease in France.

Study Design: Data from the national confidential enquiry into maternal deaths and from reference centres for sickle-cell disease were examined to identify women with this disease who died in France during 1996-2009. The maternal mortality ratio among women with sickle-cell disease was estimated and compared with the ratio in the general population.

Invasive therapies for primary postpartum haemorrhage: a population-based study in France.

Objective: To describe the characteristics, management, and outcomes of women undergoing invasive therapies for primary postpartum haemorrhage (PPH).

Design: A population-based observational study.

Setting: All 106 maternity units of six French regions.

Pregnancy-related ICU admissions in France: trends in rate and severity, 2006-2009.

Objective: To determine the national rate per delivery of pregnancy-related ICU admissions of women in France, the characteristics and severity of these cases, and their trends over the 4-year study period.

Design: Descriptive study from the national hospital discharge database.

Setting: All ICUs in France.

Pitfalls of national routine death statistics for maternal mortality study.

Background: The lessons learned from the study of maternal deaths depend on the accuracy of data. Our objective was to assess time trends in the underestimation of maternal mortality (MM) in the national routine death statistics in France and to evaluate their current accuracy for the selection and causes of maternal deaths.

Methods: National data obtained by enhanced methods in 1989, 1999, and 2007-09 were used as the gold standard to assess time trends in the underestimation of MM ratios (MMRs) in death statistics.

Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement.

Unlabelled: Severe postpartum haemorrhage after vaginal delivery: a statistical process control chart to report seven years of continuous quality improvement

Objective: To use statistical process control charts to describe trends in the prevalence of severe postpartum haemorrhage after vaginal delivery. This assessment was performed 7 years after we initiated a continuous quality improvement programme that began with regular criteria-based audits

Study Design: Observational descriptive study, in a French maternity unit in the Rhône-Alpes region.

Intervention: Quarterly clinical audit meetings to analyse all cases of severe postpartum haemorrhage after vaginal delivery and provide feedback on quality of care with statistical process control tools.

Ten years of confidential inquiries into maternal deaths in France, 1998-2007.

Objective: To assess trends in the maternal mortality ratio over a 10-year period in France and the causes, risk factors, quality of care, and avoidability of maternal deaths.

Methods: Maternal deaths up to 1 year after the end of the pregnancy from 1998 to 2007 were identified and studied through the French Confidential Enquiry Into Maternal Deaths system. Time trends were analyzed by comparing the two 5-year periods for maternal mortality ratios, both overall and by women's characteristics, causes of death, existence of suboptimal care, and avoidability.

[Maternal mortality in France, 2007-2009].

To monitor the maternal mortality which is an indicator of the quality of obstetric and intensive care, France has a specific approach since 1996. Recently linkages have been introduced to improve the inclusion of cases. Here are the results for the 2007 to 2009 period.

Postpartum haemorrhage in Canada and France: a population-based comparison.

Objective: Maternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries.

Methods: Using data between 2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N = 6,660 PPH) and Canada (N = 9,838 PPH).

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

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.

Induction of labor and risk of postpartum hemorrhage in low risk parturients.

Objective: Labor induction is an increasingly common procedure, even among women at low risk, although evidence to assess its risks remains sparse. Our objective was to assess the association between induction of labor and postpartum hemorrhage (PPH) in low-risk parturients, globally and according to its indications and methods.

Method: Population-based case-control study of low-risk women who gave birth in 106 French maternity units between December 2004 and November 2006, including 4450 women with PPH, 1125 of them severe, and 1744 controls.

Reporting of perinatal health indicators for international comparisons--enhancing the appearance of geographical plots.

Background: Tabulating annual national health indicators sorted by outcome may be misleading for two reasons. The implied rank order is largely a result of heterogeneous population sizes. Distinctions between geographically adjacent regions are not visible.

Transfusion practices in postpartum hemorrhage: a population-based study.

Objective: To describe transfusion practices and anemia in women with postpartum hemorrhage (PPH), according to the clinical context.

Design: Population-based cohort study.

Setting: A total of 106 French maternity units (146 781 deliveries, December 2004 to November 2006).

[French hospital discharge database: data production, validity, and origins of errors in the field of severe maternal morbidity].

Background: The organization of obstetric care in France brings all women in contact with the hospital system. Thus, hospital discharge data from the Program of Medicalization of the Information System (PMSI) constitute a potentially valuable source of information, particularly regarding rare events such as severe maternal morbidity. These data cover a large population but their quality has not been assessed in that field.

What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe.

Objective: To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity.

Design: Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries.

Setting: Twenty-five countries in the European Union and Norway.