Épidémiologie de la mortalité maternelle en France, fréquence et caractéristiques

Since August 2004, a law in Public health has defined indicators for the monitoring of the health status of the population in France, including maternal mortality. Before that a strengthen system of recording and analysis of the maternal deaths has been established by medical certificate of death and confidential enquiries into maternal deaths. Whereas observation of severe events at hospital are taking increasing importance, the present paper aims to draw the lessons learnt in the field of maternal health. In routinely collected data, maternal mortality ratio is generally underestimated at 7 per 100 000 live births versus the probable actual ratio of 9. More than 3/4 women arrived in an extremely bad condition to intensive care unit (ICU) before dying. Half of deaths were considered avoidable by the National Committee because of substandard care. Main risk factors are an age > 35, a non European nationality and the cesarean delivery by itself. The insufficient level of care was particularly taken out in post-partum haemorrhage (PPH), first cause of maternel death in France. Nor the management of third stage of delivery neither evidence based clinical practices in case of severe PPH are used in due time. This sort of approaches (clinical audit, randomized trial, evaluation studies) might be a model for studying other maternal emergencies in obstetric. New studies are requested in the obstetric complications of which a high proportion of deaths has been considered avoidable in order to investigate relationship between mode of delivery and ICU admission.