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).

Design: A population-based observational study.

Setting: All 106 maternity units of six French regions.

Population: 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.

Main outcome measures: 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.

Tweetable abstract: Maternal mortality as a result of haemorrhage and the rate of invasive therapies used for PPH are high in France.

Keywords: Embolisation; hysterectomy; maternal mortality; pelvic vessel ligation; postpartum haemorrhage; uterine compression sutures.