%0 Journal Article %T Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study %+ CHU Estaing [Clermont-Ferrand] %+ Institut Pascal (IP) %+ CHU Clermont-Ferrand %+ Université Clermont Auvergne (UCA) %+ Université Claude Bernard Lyon 1 (UCBL) %+ CHU Caen %+ CHU Gabriel Montpied [Clermont-Ferrand] %A Vendittelli, Françoise %A Barasinski, Chloé %A Rivière, Olivier %A da Costa Correia, Caroline %A Crenn-Hébert, Catherine %A Dreyfus, Michel %A Legrand, Anne %A Gerbaud, Laurent %< avec comité de lecture %@ 2227-9032 %J Healthcare %I MDPI %V 10 %N 6 %P 992 %8 2022-06 %D 2022 %R 10.3390/healthcare10060992 %M 35742043 %Z Life Sciences [q-bio]/Santé publique et épidémiologie %Z Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetricsJournal articles %X Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures. %G English %2 https://hal.uca.fr/hal-03717345/document %2 https://hal.uca.fr/hal-03717345/file/Impact%20of%20HPP%20local%20protocols.pdf %L hal-03717345 %U https://hal.uca.fr/hal-03717345 %~ PRES_CLERMONT %~ CNRS %~ UNIV-BPCLERMONT %~ UNIV-LYON1 %~ SANTE_PUB_INSERM %~ INSTITUT_PASCAL %~ COMUE-NORMANDIE %~ ACL-SVSAE %~ CHU-CLERMONTFERRAND %~ UDL %~ UNIV-LYON %~ CLERMONT-AUVERGNE-INP %~ TEST3-HALCNRS