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

PLoS One. 2013 Jun 24;8(6):e66882. doi: 10.1371/journal.pone.0066882. Print 2013.


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). We assessed factors associated with PPH through multivariate logistic models.

Results: PPH incidence, overall (4.8% (95% CI 4.7-4.9) in Canada and 4.5% (95% CI 4.4-4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2-5.4) in Canada and 4.8 (95%CI 4.7-4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23-1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery.

Conclusion: PPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada / epidemiology
  • Delivery, Obstetric / statistics & numerical data
  • Female
  • France / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Intensive Care Units / statistics & numerical data
  • Postpartum Hemorrhage / diagnostic imaging
  • Postpartum Hemorrhage / epidemiology*
  • Postpartum Hemorrhage / surgery
  • Pregnancy
  • Radiography
  • Risk Factors

Grant support

The Pithagore6 project was funded by the French Ministry of Health under its Clinical Research program (contract n°27–35). This study was supported by doctoral grants from the AXA Research Funds, the French Society of Anesthesiology (SFAR) and the Assistance Publique-Hôpitaux de Paris (AP-HP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.