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

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

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

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.

Original language	English
Article number	102665
Pages (from-to)	1-8
Number of pages	8
Journal	Preventive medicine reports
Volume	40
Early online date	23 Feb 2024
DOIs	https://doi.org/10.1016/j.pmedr.2024.102665
Publication status	Published - Apr 2024

Bibliographical note

Publisher Copyright:
© 2024 The Author(s)

Funding

For the Epimoms data: The authors thank the coordinators of the participating regional perinatal networks (Alsace, Aurore, Auvergne, Basse-Normandie, MYPA, NEF, Paris Nord, 92 nord, Lorraine) for their help in the coordination of women's inclusion and data collection in their region; Chloé BARASINSKI, Sophie BEDEL, Aline CLIN D'AMOUR, Laurent GAUCHER, Isabelle LECREFF, Blandine MASSON, Carole RAMOUSSET, Mathias ROSSIGNOL, Zelda STEWART, Dalila TALAOURAR, Yacine TOURE, and Nicole WIRTH for their contribution to the implementation of the EPIMOMS study in their regions; the obstetricians, midwives, and anesthesiologists who contributed to case identification and documentation in their hospitals; the research assistants who collected the data and Coralie Chiesa-Dubruille for the national supervision of study implementation. For the Tempoh data: We would like to thank all 61 participating hospitals and the Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology – NVOG Consortium 2.0, medical students R.M. Loeff, R.J. van Goeverden, B. Eijlers, A.Hillebrand, S.E. Spelmink, T.J. Beunder, V. Harskamp, M. Wind, M.D. Koning, R.A. Cramer, A. Veenstra, S.M. Smith and E.E. Ensing, datamanagers C.J. van Brussel-de Groot and O. Zouitni, and research nurses C. Kolster-Bijdevaate, M.S. Bourgonje-Verhart, C.E. Bleeker-Taborh and E. Roos-van Milligen for their contributions to the data collection for the TeMpOH-1 study.

Funders	Funder number
Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology
MYPA
NVOG Consortium
Nagao Natural Environment Foundation

Keywords

Clinical care
Cross-country studies
Management
Maternal morbidity
Maternal mortality
Obstetric hemorrhage
Severe maternal outcome

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de Vries, P. L. M., Deneux-Tharaux, C., Caram-Deelder, C., Goffinet, F., Henriquez, D. D. C. A., Seco, A., van der Bom, J. G., & van den Akker, T. (2024). Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands. Preventive medicine reports, 40, 1-8. Article 102665. https://doi.org/10.1016/j.pmedr.2024.102665

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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",

author = "{de Vries}, {P. L.M.} and C. Deneux-Tharaux and C. Caram-Deelder and F. Goffinet and Henriquez, {D. D.C.A.} and A. Seco and {van der Bom}, {J. G.} and {van den Akker}, T.",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = apr,

doi = "10.1016/j.pmedr.2024.102665",

language = "English",

volume = "40",

pages = "1--8",

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de Vries, PLM, Deneux-Tharaux, C, Caram-Deelder, C, Goffinet, F, Henriquez, DDCA, Seco, A, van der Bom, JG & van den Akker, T 2024, 'Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands', Preventive medicine reports, vol. 40, 102665, pp. 1-8. https://doi.org/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. / de Vries, P. L.M.; Deneux-Tharaux, C.; Caram-Deelder, C. et al.
In: Preventive medicine reports, Vol. 40, 102665, 04.2024, p. 1-8.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Severe postpartum hemorrhage and the risk of adverse maternal outcome

T2 - A comparative analysis of two population-based studies in France and the Netherlands

AU - de Vries, P. L.M.

AU - Deneux-Tharaux, C.

AU - Caram-Deelder, C.

AU - Goffinet, F.

AU - Henriquez, D. D.C.A.

AU - Seco, A.

AU - van der Bom, J. G.

AU - van den Akker, T.

PY - 2024/4

Y1 - 2024/4

N2 - 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.

AB - 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.

KW - Clinical care

KW - Cross-country studies

KW - Management

KW - Maternal morbidity

KW - Maternal mortality

KW - Obstetric hemorrhage

KW - Severe maternal outcome

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DO - 10.1016/j.pmedr.2024.102665

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M1 - 102665

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

Abstract

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