Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions

Objective To determine what factors related to health services in France mi ght explain substandard care of severe morbidity due to obstetric haemorrha ge. Design Retrospective questionnaire survey. Setting Three administrative regions of France. Population All women who were pregnant or had recently given birth during t he year before the survey. Methods A European survey (MOMS-B) defined severe haemorrhages as blood los s greater than or equal to 1500mL. A specific questionnaire was added in Fr ance to analyse the quality of care of these haemorrhages. The survey was c arried out in three different administrative regions: Champagne-Ardenne, th e Centre and Lorraine, An expert committee was appointed and began by estab lishing a framework for qualitative assessment. One hundred and sixty-five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and 'mixe d' care were both considered substandard. The 165 cases were coded and then studied with uni- and multivariate analysis (logistic regression with SAS and SPSS software). Results Of the 165 cases identified, 51 % (85/165) were vaginal, 19% (31/16 5) operative vaginal, and 30% (49/165) caesarean. The leading cause of haem orrhage was uterine atony. Overall, 62% of the cases received appropriate c are, 24% received totally inadequate care and 14% mixed care. After adjustm ent for sociodemographic factors, antenatal care and organisational aspects , the lack of a 24-hour on-site anaesthetist at the hospital and a low volu me of deliveries (< 500 births per year) were the factors associated with s ubstandard care. Conclusion Organisational features are so important that application of goo d clinical practices for safer motherhood reinforce the need for new organi sation of obstetric services. For the first time, the presence of an anaest hetist is shown to have a measurable effect on the quality of care for wome n giving birth. These results need to be confirmed by others.