Major post-partum hemorrhage rate in a I level hospital: data analysis of substandard care and near-miss cases.

Abstract

BACKGROUND: Post-partum hemorrhage continues to be a leading cause of maternal mortality and morbidity. The aim of this study was to estimate the prevalence of major hemorrhage, near-miss cases and substandard care in a I level hospital. METHODS: We conducted a retrospective cohort study of pregnant women between 2003 and 2018 who had a blood loss ≥1500 mL or who required one or more blood transfusions. We assessed near-miss cases and substandard care. RESULTS: Over the 16 years, there were 14,523 births: 156 women (1.07%) had a blood loss ≥1500 mL or required one or more blood transfusions. There were 16 near-miss cases and no maternal deaths. Twenty-three cases required transfer to the Intensive Care Unit (11.5%), in 3.5% of non near-miss cases and in 81.2% of near-miss cases (P<0.001). We identified substandard care in 36.4% of low risk women, and in 62.5% of near-miss cases (P=0.04). CONCLUSIONS: After dividing the cases in a first period (2003-2010) and a second period (2011-2018), we highlighted 11.6% near-miss cases in the first period and 8.8% in the second period (P=NS). The procedures adopted following the failure of the pharmacological therapy changed over the two periods: uterine packs with sterile gauzes went from 17.9% in the 2003-2010 timeframe, to 2.4% in the 2011-2018 (P=0.01). While the use of uterine balloon went from 12.8% (2003-2010) to 64.3% (2011-2018) (P<0.001).