Between 2010 and 2012, 256 women lost ir lives during ir pregnancy or childbirth in France. This figure has decreased by one third in 10 years but remains stable since 2007.
The confidential survey of maternal deaths (EPOPé) led by Carine Deney Tharaux, an epidemiologist at Inserm, aims to identify causes of death of women occurring before, during or after childbirth. The aim is to bring about measures that can improve possible malfunctions.
Obstetric hemorrhages divided by 2 in 10 years
At origin of nearly one in 10 deaths at childbirth, postpartum hemorrhage is first cause of maternal mortality and occurs at time of expulsion of placenta. If mor loses a lot of blood (at least 500 milliliters) and bleeding is not stopped, this complication can lead to death. In its study, Inserm announces halving of number of women who have died of hemorrhage over past 10 years. Results that testify to an improvement in quality of obstetric care in France.
However, 56% of deaths from hemorrhage occurred are considered “preventable” or “possibly preventable”. In more than half of cases, care was not considered to be optimal. Carine Deney Tharaux states that most often in se situations, “This is hemorrhaging after caesarean section.” After intervention, mor starts to bleed inside belly, blood is not out refore not visible to naked eye. The diagnostic delay n causes delay of support. Although France is in European average, margins of progress are still possible, according to authors of study.
Disparities persist
The Inserm report also reveals territorial disparities. In fact, one in seven deaths due to childbirth occurs in overseas departments. In se regions, 40 women out of 100,000 die when issuing against 9 out of 100,000 in Metropolis. “Disparities are multifactorial.” In se territories, women have a different metabolic profile, pre-existing pathologies at pregnancy are diagnosed on this occasion, so belatedly. It is also organization of care mselves. The turnover of doctors is important, so it is difficult to establish a protocol of care in long term. “This is not a lack of material resource,” says Carine Deney Tharaux.
The survey also highlights social disparities. The mortality of migrant women is 2.5 times more important than for women born in France. This imbalance is increasing when it comes to women born in sub-saharan Africa, for whom risk is more than three times more important. Studies show that se women have often benefited from less good prenatal follow-up. There are also problems of diagnostic delay related to language barrier. This shows importance of possibility of using interpreters in maternity, explains director of survey.
According to Carine Deney Tharaux, maternal mortality remains stable since 2007 because “if care improves, which explains decrease in number of hemorrhages”, it just compensates for new risk factors such as increase in age of childbirth or obesity, which make future mors more vulnerable.
Although study stopped in 2012, it could not be published earlier. Several sources of data are indeed needed to identify cases of maternal deaths. We are relying on direct statements and civil status data. But what takes more time to collect se are death certificates as y are still in paper format. To do so we work with CÉPIDC, organization that provides official mortality statistics, but currently has 3 years of delay on processing of certificates. The investigation is ongoing and is still ongoing at present time. However, data for years 2013 to 2017 are not yet exhaustive, explains Carine Deney Tharaux.
Big Bang Santé, House of Chemistry in Paris, 26 October 2017, from 8.30 am to 7 pm.
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