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Poster Session 2

(555) Influence of French Labor-management Guidelines on Incidence of Severe Postpartum Hemorrhage: A national population-based study

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Mathilde Lepelletier, N/A (she/her/hers)

    Resident
    INSERM UMR 1153, Obstetrical , Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris
    Paris, Ile-de-France, France

    • Coauthor(s)

  • Camille Le Ray, MD, PhD (she/her/hers)

    Professor
    INSERM 1153, APHP, Port Royal maternity unit, Université de Paris
    Paris, Ile-de-France, France

  • Aude Girault, MD, PhD (she/her/hers)

    FHU PREMA, Paris, France. FHU PREMA, Paris, France; Université Paris Cité, Inserm, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.
    Paris, Ile-de-France, France

Objective: The 2021 French National Perinatal Survey (FNPS) revealed an increased rate of severe postpartum hemorrhage (PPH) since the previous survey in 2016. This rise might be attributed not only to the evolution of maternal risk factors but also to the publication of the 2017 guidelines that aimed at restricting labor interventions, such as oxytocin administration, for women in spontaneous labor. Our aim was to explore the association between changes in medical practice between 2016 and 2021 and incidence of severe PPH.

Study Design: Women who participated to the 2016 and 2021 FNPS and delivered of a term live-born cephalic singleton after a spontaneous labor were included. We described the evolution of severe PPH rate, oxytocin use, and labor duration. We then assessed the determinants of severe PPH using univariate and multivariable analyses adjusting on maternal characteristics. Finally, we investigated the potential mediation effect of oxytocin use and prolonged labor on the relationship between the year of delivery and the occurrence of severe PPH.

Results:

A total of 14,168 women were included, 7,529 in 2016 and 6,639 in 2021. The incidence of severe PPH increased from 1.2% in 2016 to 2.0% in 2021, p< 0.01. The use of oxytocin during labor decreased from 45.0% in 2016 to 30.2% in 2021, p< 0.01. Labor duration were significantly longer in 2021, regardless of parity (p < 0.01) After adjusting for maternal, obstetrical and maternity unit characteristics, giving birth in 2021 (versus 2016) remained associated with an increased risk of severe PPH (OR 1.7 [1.3-2.2]). While oxytocin use did not appear as a mediating factor, prolonged labor mediated only 9% of the observed association between the year of delivery and the risk of severe PPH.


Conclusion:

While the French Labor management Guidelines could partially explain the increase in severe PPH rates observed between 2016 and 2021, the decrease in the use of oxytocin does not appear to be associated with this increase.