[Perinatal mortality and quality of clinical management in the Aurore network from 2005 to 2011. Implementation of morbidity and mortality conferences]. / Mortalité périnatale et qualité des prises en charge au sein du réseau Aurore de 2005 à 2011. Mise en place des réunions de morbi-mortalité au sein du réseau.

OBJECTIVES: Evaluate the incidence of perinatal mortality and evaluate the percentage of non optimal care management of fatal pregnancies between 2005 and 2011 in the Rhone-Alpes region in France, by the use of the Aurore network. Evaluate the development of morbi-mortality revues (MMR) in this region. METHODS: Retrospective study of perinatal mortality in the Aurore network, from 2005 to 2011. Systematic analysis of care management (adapted, non adapted, non evaluable), of each perinatal death that occurred in the Aurore network, by a multidisciplinary committee during regional MMR. RESULTS: The incidence of perinatal mortality has diminished from 2005 to 2011 (8,4‰ vs. 6,4‰, P<0.07) as well as the percentage of non adapted care management (13% vs. 5,6%, P<0.001). An underestimation of irregularities in the fetal heart rate was described in 34% of per partum deaths. The percentage of optimal care management was significantly higher when the obstetrician was in the maternity rather than on call at home (P<0.03) and in type 3 maternities compared to type 1 and 2 maternities (P<0.04). The attendance of the MMR organized in the AURORE network progressed between 2006 and 2011. CONCLUSION: Since 2005, a decrease in perinatal mortality and in non-adapted care management was observed. More studies are necessary to evaluate the link between the development of MMR in this network and the amelioration of these two indicators.

Bedside assessment of fibrinogen level in postpartum haemorrhage by thrombelastometry.

OBJECTIVES: To establish whether reagent-supported thrombelastometry with the rotation thrombelastometry system (ROTEM) point-of-care device correlated with fibrinogen level in postpartum haemorrhages. DESIGN: Prospective observational study. POPULATION AND SETTING: Ninety-one women at the third trimester of pregnancy: 37 with postpartum haemorrhage (study group) and 54 without abnormal bleeding (control group). METHODS: Standard laboratory test results were compared with those obtained at bedside from the ROTEM with the FIBTEM test (54 tests in the control group and 51 in the study group). MAIN OUTCOME MEASURES: Analysis of correlations between fibrinogen levels and FIBTEM test results: clotting time (CT), clot amplitude at 5 and 15 minutes (CA5; CA15) and maximal amplitude [maximum clot firmness (MCF)]. RESULTS: Median fibrinogen level was significantly lower in the haemorrhage group than in the control group (3.4 and 5.1 g/l, respectively, P < 0.0001). Median CT was higher in the haemorrhage group than in the control group (P = 0.05). CA5, CA15 and MCF were significantly lower in the haemorrhage group than in controls (P < 0.0001) and strongly correlated with fibrinogen levels in both groups (r = 0.84-0.87, P < 0.0001). A cut-off value of CA5 at 5 mm and CA15 at 6 mm presented an excellent sensitivity (100% for both parameters) and a good specificity (respectively 85 and 88%) to detect fibrinogen levels <1.5 g/l in postpartum haemorrhage. Conclusions The early parameters obtained from the FIBTEM test correlated well with fibrinogen levels. ROTEM might be helpful in guiding fibrinogen transfusion during postpartum haemorrhage.

[Which future for Rhône-Alpes area obstetrical units? Thoughts of demography survey on Rhône-Alpes area obstetricians]. / Quel avenir pour les maternités de la région Rhône-Alpes? Réflexions à propos d'une enquête démographique réalisée auprès des obstétriciens de la région Rhône-Alpes.

OBJECTIVE: To describe the demography of obstetricians who practice an obstetrical activity and to forecast the needs of practitioners at five and 10years in Rhône-Alpes area. MATERIAL AND METHOD: Descriptive survey on 58maternities of Rhône-Alpes area in 2007. RESULTS: A total of 56maternities provided sufficient data. It was found that 321obstetricians actually had an obstetrical activity (deliveries, maternity ward). The average age of obstetricians was 40,9years for those practicing in teaching hospitals, 50,4years in other public hospitals and 52,6years in private settings. The needs in obstetricians for Rhône-Alpes area are expected to be 80 in five years and 150 in 10years. Considering the number of young obstetricians who choose obstetrical practice, the lack of obstetricians is expected to be 55 in five years and 100 in 10years. CONCLUSION: It's urgent to take measures to increase the number of student in gynaecology and obstetrics stream and to encourage junior obstetrician to choose obstetrical activity.