Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands

P L M de Vries; C Deneux-Tharaux; C Caram-Deelder; F Goffinet; D D C A Henriquez; A Seco; J G van der Bom; T van den Akker

doi:10.1016/j.pmedr.2024.102665

Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands

Prev Med Rep. 2024 Feb 23:40:102665. doi: 10.1016/j.pmedr.2024.102665. eCollection 2024 Apr.

Authors

P L M de Vries^{1

2}, C Deneux-Tharaux³, C Caram-Deelder⁴, F Goffinet^{2

3}, D D C A Henriquez⁴, A Seco⁵, J G van der Bom⁴, T van den Akker^{1

6}

Affiliations

¹ Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
² Port-Royal Maternity Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ Université Paris Cité, Inserm, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (Epopé), CRESS UMR 1153, Paris, France.
⁴ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
⁵ Clinical Research Unit Necker Cochin, APHP, Paris, France.
⁶ Athena Institute, VU University, Amsterdam, The Netherlands.

Abstract

Objectives: Among women with severe PPH (sPPH) in France and the Netherlands, we compared incidence of adverse maternal outcome (major obstetric hemorrhage (≥2.5L blood loss) and/or hysterectomy and/or mortality) by mode of delivery. Second, we compared use and timing of resuscitation and transfusion management, second-line uterotonics and uterine-sparing interventions (intra-uterine tamponade, compression sutures, vascular ligation, arterial embolization) by mode of delivery.

Methods: Secondary analysis of two population-based studies of women with sPPH in France and the Netherlands. Women were selected by a harmonized definition for sPPH: (total blood loss ≥ 1500 ml) AND (blood transfusion of ≥ 4 units packed red blood cells and/or multicomponent blood transfusion).

Findings: Incidence of adverse maternal outcome after vaginal birth was 793/1002, 9.1 % in the Netherlands versus 88/214, 41.1 % in France and 259/342, 76.2% versus 160/270, 59.3% after cesarean. Hemostatic agents such as fibrinogen were administered less frequently (p < 0.001) in the Netherlands (vaginal birth: 83/1002, 8.3% versus 105/2014, 49.5% in France; cesarean: 47/342, 13.7% and 152/270, 55.6%). Second-line uterotonics were started significantly later after PPH-onset in the Netherlands than France (vaginal birth: 46 versus 25 min; cesarean: 45 versus 18 min). Uterine-sparing interventions were less frequently (p < 0.001) applied in the Netherlands after vaginal birth (394/1002,39.3 %, 134/214, 62.6%) and cesarean (133/342, 38.9 % and 155/270, 57.4%), all initiated later after onset of refractory PPH in the Netherlands.

Interpretation: Incidence of adverse maternal outcome was higher among women with sPPH in the Netherlands than France regardless mode of birth. Possible explanatory mechanisms are earlier and more frequent use of second-line uterotonics and uterine-sparing interventions in France compared to the Netherlands.

Keywords: Clinical care; Cross-country studies; Management; Maternal morbidity; Maternal mortality; Obstetric hemorrhage; Severe maternal outcome.