[Maternal mortality due to Amniotic Fluid Embolism in France 2016-2018]. / Mortalité maternelle par embolie amniotique en France 2016­2018.

Amniotic embolism remains the 3rd leading cause of maternal death in France, with 21 maternal deaths over the 2016-2018 triennium. The women who died were more likely to be obese (25%), to benefit from induction of labor (71%) and be cared in a maternity hospital <1500 deliveries/year (45%), compared with the reference population (ENP 2016). The symptom occurred mainly during labor (95%) and the course was rapid, with a symptom-to-fatality interval of 4hours 45minutes (min: 25minutes - max: 8 days). Preventability was proposed for 35% of the deaths assessed, with areas for improvement identified in terms of technical skills (haemostasis procedures, management of polytransfusion), non-technical skills (communication) and health care organization (human resources, vital emergency plan, wide access to PSL). An autopsy was performed in 38% of deaths.

[Maternal mortality among socially vulnerable women in France 2016-2018]. / Mortalité maternelle chez les femmes avec vulnérabilité sociale en France 2016­2018.

Social vulnerability is a known factor in perinatal medical risk, both for the foetus and the mother. As part of the French confidential enquiry into maternal deaths, the introduction in 2015 of specific items relating to social status has made it possible to recreate this composite variable. Over the period 2016-2018, one woman in three who died was in a situation of social vulnerability. Of these 79 deaths, 32 (41%) were related to direct obstetric causes, 26 (33%) to indirect obstetric causes, 12 (15%) to suicides and 8 (10%) of unknown cause. Care was considered sub-optimal in 73% of cases, compared with 64% in the group of maternal deaths with no identified social vulnerability. 43 deaths were judged to be probably (n=12) or possibly (n=31) avoidable, 25 were not avoidable, and 11 were not sufficiently documented for this assessment; i.e. a proportion of 63% of probable or possible avoidability, a higher proportion compared with the 56% of avoidability among women with no identified social vulnerability. In 1/3 of maternal deaths, a lack of interaction between the woman and the healthcare system was involved in the chain of events leading to death, i.e. 2 times more than in the case of socially non-vulnerable women. Improving the interaction of women in socially vulnerable situations with the hospital system and the institutional and voluntary networks providing care, support and assistance is a priority. A specific, responsive medical and social organisation could contribute to this.

Selective prophylactic transfusion in sickle cell disease.

OBJECTIVE. To record feto-maternal complications following the use of selective prophylactic transfusions in women with major sickle cell disease (SCD) and determine whether selective prophylactic transfusion reduces these complications, through a comparison with a population of women who received transfusions for complications only. DESIGN. A retrospective cohort study. SETTING. Public regional referral hospital in western French Guyana. POPULATION. Between 1992 and 2004, in all 29 women, 55 pregnancies, and 56 neonates. METHODS. Close obstetric follow-up and selective prophylactic transfusions after 26 weeks. Main outcome measures. Adverse obstetric outcome (pre-eclampsia, preterm delivery, intrauterine growth restriction (IUGR), intrauterine fetal death (IUFD), cesarean delivery, neonatal and maternal mortality) and end-points for SCD outcome (vaso-occlusive crisis (VOC), acute chest syndrome, and infections). RESULTS. Complications involved the different major SCD types to an equal extent. Comparison with the control group showed that women who had received prophylactic transfusions had lower rates of VOC (p=0.002) and preterm deliveries (p=0.036), but a significant increase in IUGR cases (p=0.048). CONCLUSION. Selective prophylactic transfusion seems to reduce certain maternal and fetal complications in women with severe forms of SCD. These results can only be confirmed through a randomized prospective study.