Morau E, Ducloy J C, Le Roux S, Weber P, Dreyfus M
Service d'anesthésie-réanimation, CHU de Nîmes, place du Pr. Robert-Debré, 30029 Nîmes, France.
Hôpital privé Villeneuve d'Ascq, 20, avenue de la Reconnaissance, 59491 Villeneuve d'Ascq, France.
Gynecol Obstet Fertil Senol. 2021 Jan;49(1):60-66. doi: 10.1016/j.gofs.2020.11.011. Epub 2020 Nov 6.
Maternal death from haemorrhage is decreasing: in the last 15 years the number of deaths has been halved. This improvement demonstrates the progress made in hemorrhage management as a result of collective efforts. The number of deaths in this triennium is 22, representing 8.4% of maternal deaths and a maternal mortality ratio by haemorrhage of 1.0/100,000 live births. Nevertheless, there is a worrying proportion of deaths from occult haemorrhage. These occult haemorrhages most often occurred after caesarean sections. A lack of surveillance in the immediate follow-up was generally associated. One or more factors of sub-optimal care were present in 84% of the cases, and 88.9% of deaths were considered possibly or probably preventable. Delay in the diagnosis of haemorrhage, delay in surgical treatment, an insufficient transfusion strategy and inappropriate locations of care were the most frequently reported factors. The experts suggest that risk factors for haemorrhage should be identified in order to propose the most appropriate facility for childbirth. They encourage the strategies for early diagnosis of haemorrhage (attentive and regular monitoring, rapid haemoglobin measurement, abdominal ultrasound) and surgical intervention in case of hemoperitoneum.
在过去15年中，死亡人数减半。这一改善表明，通过集体努力，在出血管理方面取得了进展。本三年期内的死亡人数为22人，占孕产妇死亡人数的8.4%，出血导致的孕产妇死亡率为每10万活产1.0例。然而，隐匿性出血导致的死亡比例令人担忧。这些隐匿性出血最常发生在剖宫产术后。通常与产后立即随访缺乏监测有关。84%的病例存在一个或多个护理欠佳因素，88.9%的死亡被认为可能或很可能是可预防的。出血诊断延迟、手术治疗延迟、输血策略不足以及护理地点不当是最常报告的因素。专家建议，应确定出血的危险因素，以便为分娩推荐最合适的机构。他们鼓励采取出血早期诊断策略（密切和定期监测、快速血红蛋白测量、腹部超声）以及在发生腹腔积血时进行手术干预。
