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Cravassac L, Hamadmad R, Crequit S, Redel D, Yakhou L, Verton C, Haddad B, Lecarpentier E. Clinical and biological factors associated with red blood cell transfusion during severe postpartum haemorrhage - A single-center retrospective cohort study. J Gynecol Obstet Hum Reprod 2024; 53:102774. [PMID: 38521407 DOI: 10.1016/j.jogoh.2024.102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Red blood cell (RBC) transfusions are of utmost importance in the management of severe post-partum haemorrhage. Although the recommendations for blood transfusion protocols are regularly issued, there are significant differences in management depending on the context and the medical teams involved. OBJECTIVE To determine during the first 24 h, the clinical and biological factors associated with the decision for RBC transfusion during severe PPH (≥1000 mL) for vaginal and caesarean deliveries. STUDY DESIGN Monocentric retrospective study conducted in a tertiary care university maternity unit (CHI-Creteil) including all parturients from November 23th 2018 to 31th December 2020 with severe PPH (≥1000 mL). RESULTS Over the study period, we reported 7103 deliveries, out of which 682 were complicated by PPH (9.6 %) with 200 cases of PPH ≥1000 mL (2.8 %). In our study, 40 % of patients (80/200) required a RBC transfusion". After multivariate analysis, severe PPH caused by placental abruption, uterine rupture or placental implantation disorders (aOR = 3.48 IC95 [1.27-9.52], p < 0.001), estimated blood loss ≥1500 mL (aOR = 9.60 IC95 [3.69-24.95], p < 0. 001), invasive measures such as uterine balloon tamponade, arterial ligation and uterine packing (aOR = 4.15 IC95 [1.80-9.61], p < 0.001), pre-labor hemoglobin <10 g/dL (aOR =4.88 IC95 [1.57-15.15], p < 0.001) or abnormal biological results in the acute phase (including hemoglobin <7.0 g/dL and/or fibrinogen <2 g/L and/or platelets <100 G/L) (aOR =356 IC95 [1,05-12,10], p < 0.001) were significantly and independently associated with the decision to initiate RBC transfusions. CONCLUSIONS In a monocentric retrospective study including 200 consecutive cases of severe PPH (≥1000 mL) we identified groups of clinical and biological factors directly accessible to clinicians, significantly and independently associated with RBC transfusion in the first 24 h of management.
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Affiliation(s)
- Lauren Cravassac
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Rayan Hamadmad
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Simon Crequit
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Diane Redel
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France
| | - Leila Yakhou
- Service d'Anesthésie Réanimation, Centre Hospitalier Intercommunal de Créteil, France
| | - Caroline Verton
- Service d'Anesthésie Réanimation, Centre Hospitalier Intercommunal de Créteil, France
| | - Bassam Haddad
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Faculté de santé, Université Paris-Est Créteil, France
| | - Edouard Lecarpentier
- Service de Gynécologie Obstétrique, Centre Hospitalier Intercommunal de Créteil, France; Faculté de santé, Université Paris-Est Créteil, France; Équipe Biologie du Trophoblaste et Pathologies Vasculaires Placentaires, INSERM, CNRS, UPC, Institut Cochin, France.
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Cormier J, Merrer J, Blondel B, Le Ray C. Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study. Acta Obstet Gynecol Scand 2023; 102:438-449. [PMID: 36852493 PMCID: PMC10008350 DOI: 10.1111/aogs.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. MATERIAL AND METHODS We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. RESULTS A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). CONCLUSIONS Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.
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Affiliation(s)
- Julie Cormier
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
| | - Jade Merrer
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Clinical Epidemiology Unit, Robert Debré HospitalAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
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Sentilhes L, Galley-Raulin F, Boithias C, Sfez M, Goffinet F, Le Roux S, Benhamou D, Garnier JM, Paysant S, Bounan S, Michel C, Coudray J, Rozé JC, Elleboode B, Ducloy-Bouthors AS. Staffing needs for unscheduled activity in obstetrics and gynecology. Eur J Obstet Gynecol Reprod Biol 2019; 245:19-25. [PMID: 31821921 DOI: 10.1016/j.ejogrb.2019.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To determine a minimum threshold of medical staffing needs (obstetricians-gynecologists, anesthesiologists-resuscitation specialists, nurse-anesthetists, pediatricians, and midwives) to ensure the safety and quality of care for unscheduled obstetrics-gynecology activity. MATERIALS AND METHODS Face to face meetings of French healthcare professionals involved in perinatal care in different types of practices (academic hospital, community hospital or private practice) who belong to French perinatal societies: French National College of Gynecologists-Obstetricians (CNGOF), the French Society of Anesthesia and Resuscitation Specialists (SFAR), the French Society of Neonatology (SFN), the French Society of Perinatal Medicine (SFMP), the National College of French Midwives (CNSF), and the French Federation of Perinatal Care Networks (FFRSP). RESULTS Different minimum thresholds for each category of care provider were proposed according to the number of births/year in the facility. These minimum thresholds can be modulated upwards as a function of the level of care (Level 1, 2 or 3 for perinatal centers), existence of an emergency department, and responsibilities as a referral center for maternal-fetal and/or surgical care. For example, an obstetrics-gynecology department handling 3000-4500 births per year without serving as a referral center must have an obstetrician-gynecologist, an anesthesiologist-resuscitation specialist, a nurse-anesthetist, and a pediatrician onsite specifically to provide care for unscheduled obstetrics-gynecology needs and a second obstetrician-gynecologist available within a time compatible with security requirements 24/7; the number of midwives always present (24/7) onsite and dedicated to unscheduled care is 5.1 for 3000 births and 7.2 for 4500 births. A maternity unit's occupancy rate must not exceed 85 %. CONCLUSION The minimum thresholds proposed here are intended to improve the safety and quality of care of women who require unscheduled care in obstetrics-gynecology or during the perinatal period.
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Affiliation(s)
- Loïc Sentilhes
- Collège National des Gynécologues Obstétriciens Français (CNGOF), France; Société Française de Médecine Périnatale (SFMP), France; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - Fabienne Galley-Raulin
- Collège National des Sages-femmes de France (CNSF), France; Pôle Mère-Enfant, Verdun, St Mihiel, France
| | - Claire Boithias
- Société Française de Médecine Périnatale (SFMP), France; Société Française de Néonatologie (SFN), France; Réanimation Pédiatrique et Néonatale, Hôpital Bicètre, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Michel Sfez
- Société Française d'Anesthésie Réanimation (SFAR), France; Clinique Oudinot, Paris, France; Club d'Anesthésie Réanimation en Obstétrique (CARO), France
| | - François Goffinet
- Collège National des Gynécologues Obstétriciens Français (CNGOF), France; Société Française de Médecine Périnatale (SFMP), France; Maternité Port-Royal, Université Paris Descartes, DHU Risques et Grossesse, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Sylvie Le Roux
- Collège National des Sages-femmes de France (CNSF), France; Pôle Femme Mère Enfant, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Dan Benhamou
- Société Française d'Anesthésie Réanimation (SFAR), France; Club d'Anesthésie Réanimation en Obstétrique (CARO), France; Pole d'Anesthésie-Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jean-Michel Garnier
- Collège National des Gynécologues Obstétriciens Français (CNGOF), France; Polyclinique de l'Atlantique, Nantes, France
| | - Sabine Paysant
- Collège National des Sages-femmes de France (CNSF), France; Centre Hospitalier du Cateau-Cambrésis, Le Cateau-Cambrésis, France
| | - Stéphane Bounan
- Collège National des Gynécologues Obstétriciens Français (CNGOF), France; Centre Hospitalier de Saint Denis, Saint-Denis, France
| | - Christine Michel
- Société Française de Néonatologie (SFN), France; Pôle Santé Léonard de Vinci, Chambray Les Tours, France
| | - Jean Coudray
- Fédération Françaises des Réseaux de Soins en Périnatalité (FFRSP), France
| | - Jean-Christophe Rozé
- Société Française de Médecine Périnatale (SFMP), France; Société Française de Néonatologie (SFN), France; Pole de Néonatologie, Centre Hospitalier Universitaire de Nantes, France
| | | | - Anne-Sophie Ducloy-Bouthors
- Société Française d'Anesthésie Réanimation (SFAR), France; Club d'Anesthésie Réanimation en Obstétrique (CARO), France; Pole Anesthésie Réanimation, Maternité Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, France
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Non-clinical interventions to prevent postpartum haemorrhage and improve its management: A systematic review. Eur J Obstet Gynecol Reprod Biol 2019; 240:300-309. [DOI: 10.1016/j.ejogrb.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
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An observational study using eye tracking to assess resident and senior anesthetists' situation awareness and visual perception in postpartum hemorrhage high fidelity simulation. PLoS One 2019; 14:e0221515. [PMID: 31465468 PMCID: PMC6715225 DOI: 10.1371/journal.pone.0221515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise. Methods Two groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load. Results No statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362). Conclusions This study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations.
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[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. ACTA ACUST UNITED AC 2018; 47:63-78. [PMID: 30579968 DOI: 10.1016/j.gofs.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.
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Abstract
OBJECTIVE To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used intrauterine balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures. RESULTS Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P<.01). Among women who delivered vaginally, the use of arterial embolization was also significantly lower in the pilot than the control network (0.2/1,000 vs 3.7/1,000, P<.01) as it was for those who delivered by cesarean (1.3/1,000 vs 5.7/1,000, P<.01). After controlling for potential confounding factors, the risk of an invasive procedure among women who delivered vaginally remained significantly lower in the pilot network (adjusted odds ratio [OR] 0.14, 95% CI 0.08-0.27), but not for women who delivered by cesarean (adjusted OR 1.19, 95% CI 0.87-1.61). CONCLUSION The use of intrauterine balloon tamponade in routine clinical practice was associated with a significantly lower use of invasive procedures for hemorrhage control among women undergoing vaginal delivery.
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[Uterine transplantation: is there a real demand?]. ACTA ACUST UNITED AC 2015; 43:133-8. [PMID: 25595943 DOI: 10.1016/j.gyobfe.2014.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the demand there is for uterus transplantation (UTx). PATIENTS AND METHODS Recent media coverage of developments in UTx prompted associations of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and of women suffering from UI to contact us. We sent them anonymous questionnaires devised to sound out their attitude towards UTx and towards adoption and gestational surrogacy (GS). A clinical psychologist also carried out a qualitative discourse analysis. RESULTS Sixty patients answered the questionnaire. Thirty-eight patients were married or living with a male partner. Seven patients had had a hysterectomy. Fifty-one patients had uterine agenesis. Of the 60 patients, 19 and 21, respectively, had ruled out the option of adoption or GS, and 11 would not envisage either possibility. Thirty-five patients were willing to take part in a clinical study into UTx despite the uncertainty of the outcome and the potential risks involved. Of these 35 volunteers, 23 were in a heterosexual relationship and aged ≤35 years. DISCUSSION AND CONCLUSION For women with UI the condition is all the more distressing because there is no medical solution for it. UTx could hold out hope for some of these patients despite the complexity of the procedure and the attendant risks. Because of the feelings of vulnerability engendered by UI, any UTx programme should provide full information to patients and ensure they are carefully screened and selected.
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Incidence, étiologies et facteurs de risque de l’hémorragie du post-partum : étude en population dans 106 maternités françaises. ACTA ACUST UNITED AC 2014; 43:244-53. [DOI: 10.1016/j.jgyn.2013.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/22/2013] [Accepted: 05/15/2013] [Indexed: 11/20/2022]
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Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH. Épidémiologie de la mortalité maternelle en France, 2007–2009. ACTA ACUST UNITED AC 2013; 42:613-27. [DOI: 10.1016/j.jgyn.2013.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
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Faut-il craindre les fermetures et fusions de maternités en France ? ACTA ACUST UNITED AC 2013; 42:407-9. [DOI: 10.1016/j.jgyn.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
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Ducloy-Bouthors AS, Prunet C, Tourrès J, Chassard D, Benhamou D, Blondel B. [Medical care organization in analgesia, anaesthesia and intensive care in maternity units: results from the National Perinatal Surveys in 2003 and 2010]. ACTA ACUST UNITED AC 2012. [PMID: 23194925 DOI: 10.1016/j.annfar.2012.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The equipment and practices in obstetric analgesia, anaesthesia and intensive care, as well as their evolution between 2003 and 2010 in metropolitan France, were described. POPULATION AND METHODS Data were derived from two representative samples of births in 2003 and 2010, based on all births in France during one week. The sample included 534 maternity units and 14,903 births in 2010 and 618 maternity units and 14,737 births in 2003. RESULTS The caesarean operating room was adjacent or inside the labour ward in 66% of maternity units in 2010 vs 56% in 2003. An anaesthetist was appointed permanently to the labour ward in 38.9% of maternity units in 2010 vs 21.5% in 2003. Locoregional analgesia or anaesthesia rate increased significantly: 81.5% in 2010 compared to 74.9% in 2003. Almost all operative vaginal deliveries were performed under epidural anesthesia in 2010. Patient controlled epidural analgesia (PCEA) was available in 58% of the units in 2010 but only 34.2% of women had PCEA. Newborn's resuscitations were performed mainly by paediatricians in 2010, but 11.4% of children were resuscitated by an anaesthetist in level 1 maternity units. CONCLUSION The conditions required to ensure anaesthetic care safety in maternity units has improved since 2003. Improvements in quality of care are still possible.
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Affiliation(s)
- A-S Ducloy-Bouthors
- Pôle anesthésie réanimation, maternité Jeanne de Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Nohuz E, Schumacher JC, Alaboud M, Dalkiliç S, Lenglet Y, Varga J, Ab Der Halden M, Chaumette D, Desroches A, Collet J, Brunel A, Dauptain G, Dognin C, Zerr V. [The obstetrics and gynaecology departments in the French public hospitals: an updated overview]. ACTA ACUST UNITED AC 2012; 41:623-30. [PMID: 23040672 DOI: 10.1016/j.jgyn.2012.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/21/2012] [Accepted: 08/24/2012] [Indexed: 11/24/2022]
Abstract
Restructuring the surgery and gynecology-obstetrics departments taking place now raise many interrogations. It appears as a mandatory necessity to some people and as a tribute to financial strategies to others to the detriment of quality and accessibility of care. Its effect is to clarify a good amount of socioeconomical and medical indicators. The plans of perinatality for the obstetrical aspect and the thresholds of activity for the surgical aspect constitute the major lines of these restructurings. A survey soliciting all the French public hospitals was used to assess the state of obstetrics and gynecology departments in the light of these recent restructurings. Medical demography, preserving and improving the quality and continuity of care, efficiency of the technical supports are discriminating criteria of the involved challenges. Such restructurings have an impact on the doctor's lives, which looks globally positive and a good omen to complete this remodeling process. The activity was safeguarded by a redistribution and a refocusing of institutions. One should not minimize the social impact of these changes, with a potential deterioration of working conditions (internal professional reclassifications, mobility obligation towards other sites). It thus appears that the deep changes which affect the small size institutions will be able to achieve well only if they are clearly done (information) and truly integrated in their medical project.
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Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, Thiers, France.
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