[Evaluation of the respect of the clinical practice guidelines in maternal transfer for postpartum haemorrhage in 2011: about 84 cases]. / État des lieux en 2011 du respect des recommandations pour la pratique clinique du transfert maternel en cas d'hémorragie du post-partum: à propos de 84 cas.

OBJECTIVES: Guidelines for the management of post-partum haemorrhage (PPH) were defined by the "Collège National des Gynécologues Obstétriciens Français (CNGOF)" since 2004. The aim of this work was to assess whether the management of PPH before and during the transfer was in accordance with national recommendations. PATIENTS AND METHODS: This is an observational monocentric prospective study concerning 84 patients transferred for PPH in a referent centre in 2011. RESULTS: In 62 cases (73.8%), transfusionnal files were found. Time noted PPH for 60 (71.4%) and amount of blood loss in 55 cases (65.5%) were notified. Evacuation of retained placenta was always performed; the broad-spectrum antibiotic prophylaxis covered only 21 cases of intra uterine procedures. Less than 5% of the patients received intravenous sulprostone before the transfer; 72.6% (n=61) of the patients were transfused before transfer 25% of the patients (n=21) had a very high risk of PPH in ante partum and were not addressed to a centre with appropriate medical and technical facilities. DISCUSSION AND CONCLUSION: Thus improvement can be made in the communication between the health care centre during transfer for PPH and the ante partum transfer of patients with high risk of PPH.

[Objective severity markers in women with severe postpartum haemorrhage: a 310-case series]. / Critères objectifs de gravité en cas d'hémorragie grave du post-partum: à propos de 310 cas.

OBJECTIVES: Postpartum haemorrhage (PPH) is a major contributor to maternal morbidity and mortality in France. The objective of our study was to reveal predictive factors of severity or cure, allowing an adapted management as less invasive as possible, in case of severe PPH. PATIENTS AND METHODS: This retrospective study included 310 patients, who had been treated for a severe PPH in Lariboisière university hospital from April 2007 to April 2009. RESULTS: The predictive factors found for an invasive management (surgery or embolization) are: at clinical examination, heart rate (88 versus 100 pulses per minute), importance of bleeding and the tonicity of the uterine globe. At biological examination, they are haemoglobin level (9 versus 8.2g/dL) and clotting factors, especially fibrinogen (3 versus 2g/L) and prothrombin time (PT) (76 versus 63%). The identified cure factors are the same ones as severity factors. With multivariate analysis, initial independent predictive factors about an invasive management were: the tonicity of the uterine globe (OR=0.14), heart frequency (OR=1.3) and PT (OR=0.76). DISCUSSION AND CONCLUSION: In case of severe haemorrhage, there may be the question of transfer of the patient. The difficulty is to avoid unnecessary transport, without delay for the future care. Very few studies searched predictive factors of severity or cure. Our study found, as predictive factors of invasive treatment, elements of physical examination (heart rate and the tonicity of the uterine globe) and biological factors (hemoglobin level and clotting factors).