@article{fdi:010065342,
  title = {{F}actors associated with postpartum hemorrhage maternal death in referral hospitals in {S}enegal and {M}ali : a cross-sectional epidemiological survey},
  author = {{T}ort, {J}. and {R}ozenberg, {P}. and {T}raore, {M}. and {F}ournier, {P}. and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {P}ostpartum hemorrhage ({PPH}) is the leading cause of maternal mortality in {S}ub-{S}aharan-{A}frica ({SSA}). {A}lthough clinical guidelines treating {PPH} are available, their implementation remains a great challenge in resource poor settings. {A} better understanding of the factors associated with {PPH} maternal mortality is critical for preventing risk of hospital-based maternal death. {T}he purpose of this study was thus to assess which factors contribute to maternal death occurring during {PPH}. {T}he factors were as follows: women's characteristics, aspects of pregnancy and delivery; components of {PPH} management; and organizational characteristics of the referral hospitals in {S}enegal and {M}ali. {M}ethods: {A} cross-sectional survey nested in a cluster randomized trial ({QUARITE} trial) was carried out in 46 referral hospitals during the pre-intervention period from {O}ctober 2007 to {S}eptember 2008 in {S}enegal and {M}ali. {I}ndividual and hospital characteristics data were collected through standardized questionnaires. {A} multivariable logistic mixed model was used to identify the factors that were significantly associated with {PPH} maternal death. {R}esults: {A}mong the 3,278 women who experienced {PPH}, 178 (5.4 %) of them died before hospital discharge. {T}he factors that were significantly associated with {PPH} maternal mortality were: age over 35 years (adjusted {OR} = 2.16 [1.26-3.72]), living in {M}ali (adjusted {OR} = 1.84 [1.13-3.00]), residing outside the region location of the hospital (adjusted {OR} = 2.43 [1.29-4.56]), pre-existing chronic disease before pregnancy (adjusted {OR} = 7.54 [2.54-22.44]), prepartum severe anemia (adjusted {OR} = 6.65 [3.77-11.74]), forceps or vacuum delivery (adjusted {OR} = 2.63 [1.19-5.81]), birth weight greater than 4000 grs (adjusted {OR} = 2.54 [1.26-5.10]), transfusion (adjusted {OR} = 2.17 [1.53-3.09]), transfer to another hospital (adjusted {OR} = 13.35 [6.20-28.76]). {T}here was a smaller risk of {PPH} maternal death in hospitals with gynecologist-obstetrician (adjusted {OR} = 0.55 [0.35-0.89]) than those with only a general practitioner trained in emergency obstetric care ({E}m{OC}). {C}onclusions: {O}ur findings may have direct implications for preventing {PPH} maternal death in resource poor settings. {I}n particular, we suggest anemia should be diagnosed and treated before delivery and inter-hospital transfer of women should be improved, as well as the management of blood banks for a quicker access to transfusion. {F}inally, an extent training of general practitioners in {E}m{OC} would contribute to the decrease of {PPH} maternal mortality.},
  keywords = {{P}ostpartum hemorrhage ; maternal mortality ; {S}ub-{S}aharan {A}frica ; {SENEGAL} ; {MALI}},
  booktitle = {},
  journal = {{B}mc {P}regnancy and {C}hildbirth},
  volume = {15},
  numero = {},
  pages = {art. 235 [9 p.]},
  ISSN = {1471-2393},
  year = {2015},
  DOI = {10.1186/s12884-015-0669-y},
  URL = {https://www.documentation.ird.fr/hor/fdi:010065342},
}