Orientador: Mary Angela Parpinelli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T19:08:15Z (GMT). No. of bitstreams: 1 Giordano_JulianaCamargo_M.pdf: 5014845 bytes, checksum: 8f26e41d63dca41f45a8a0fc08108351 (MD5) Previous issue date: 2013 / Resumo: Introdução: A mortalidade materna (MM) é um forte indicador de disparidades nos direitos das mulheres. O estudo dos casos de Near Miss (NM) é estratégico para identificar falhas no atendimento obstétrico. Em números absolutos, tanto MM quanto a ocorrência de eclâmpsia são eventos raros. Objetivo: avaliar os principais preditores de desfecho maternal grave (DMG: NM materno e MM) para eclâmpsia. Métodos: análise secundária de um estudo transversal, multicêntrico, incluindo 27 unidades obstétricas de referência de todas as cinco regiões do Brasil, entre 2009/2010. Foram identificados 426 casos de eclâmpsia e classificados de acordo com os resultados: DMG e não-DMG. As regiões brasileiras foram divididas em regiões de menor e maior renda e calculados os indicadores de cuidados obstétricos pela OMS. SPSS® e Stata® softwares foram utilizados para avaliar as características maternas, história clínica e obstétrica e o acesso aos serviços de saúde como preditores para a DMG, e correspondentes resultados perinatais, através do cálculo das razões prevalência (RP), respectivos intervalos de confiança de 95% (IC) e ainda aplicada à análise de regressão múltipla de Poisson (ajustada para o efeito cluster). Resultados: a prevalência e o índice de mortalidade por eclâmpsia em regiões de menor e maior renda foram de 0,8% / 0,2% e 8,1% / 22%, respectivamente. Dificuldades no acesso aos serviços de saúde: internação em UTI (RP ajustada 3,61, IC 95% 1,77-7,35) e monitorização inadequada (RP ajustada 2,31, IC 95% 1,48-3,59) foram associadas com DMG, também a morte perinatal foi maior neste grupo (RP ajustada 2,30; IC de 95% 1,45-3,65). Conclusão: a morbidade / mortalidade associada com eclâmpsia foi elevada no Brasil, especialmente nas regiões de baixa renda. A qualificação do atendimento à saúde materna e melhorias nos atendimentos das emergências são essenciais para aliviar a carga de eclâmpsia / Abstract: Background: Maternal mortality (MM) is a core indicator of disparities in women rights. Studying Near Miss cases is strategic to identify breakdowns in obstetrical care. In absolute numbers, both MM and the occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss). Methods: secondary analysis of a multicentre cross-sectional study, including 27 referral obstetric units from all five regions of Brazil, from 2009/2010. 426 cases of eclampsia were identified and classified according to outcomes: SMO and non-SMO. We divided Brazilian regions in lower and higher income regions and calculated the obstetric care indicators by WHO. SPSS® and Stata® softwares were used to assess the maternal characteristics, clinical and obstetrical history, access to health services as predictors for SMO, and correspondent perinatal outcomes, by calculating the prevalence ratios (PR), respective 95% confidence interval (CI) and also applying Poisson multiple regression analysis (adjusted for cluster effect). Results: prevalence and mortality index for eclampsia in lower and higher income regions were0.8%/ 0.2% and 8,1%/ 22%, respectively. Difficulties on access health care: ICU admission (adjPR 3.61; 95%CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95%CI 1.48-3.59) were associated with SMO, also perinatal death was higher in this group (adjPR 2.30; 95%CI 1.45-3.65). Conclusions: morbidity/mortality associated with eclampsia were high in Brazil, especially in lower income regions. Qualifying maternal health and improvements in emergency care are essential to relieve the burden of eclampsia / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

Orientador: José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T08:19:53Z (GMT). No. of bitstreams: 1 Santana_DaniellyScaranelloNunes_M.pdf: 8275928 bytes, checksum: b0b5d344bc32e81d7b8afbc6614f8bce (MD5) Previous issue date: 2011 / Resumo: Introdução: O aborto ainda hoje se relaciona a altas taxas de morbidade e mortalidade materna. O near miss materno, que segundo a OMS (Organização Mundial da Saúde) corresponde aquela mulher que quase morreu, mas sobreviveu a complicações durante a gestação, parto ou até 42 dias após o término da gestação, é entendido atualmente como importante marcador de saúde. Porém pouco se sabe sobre a associação do near miss com o aborto. Objetivos: avaliar a ocorrência do aborto espontâneo e induzido e da morbidade materna grave associada ao aborto, referida por mulheres em um inquérito populacional; avaliar a ocorrência de complicações maternas graves associadas ao aborto em um estudo de vigilância prospectiva de casos de complicações obstétricas graves em centros brasileiros de referência. Métodos: Um primeiro estudo foi realizado através da análise secundária da PNDS (Pesquisa Nacional de Demografia e Saúde) do Brasil de 2006, com informações de entrevistas sobre a experiência do abortamento espontâneo e induzido, fatores associados e complicações decorrentes do parto e aborto. Avaliou-se a ocorrência de morbidade materna grave associada ao abortamento e realizou-se análise múltipla por regressão logística foi utilizada para identificar os fatores independentemente associados com os dois tipos de aborto. Um segundo estudo de corte transversal multicêntrico, com vigilância prospectiva dos casos de CPAV (condição potencialmente ameaçadora da vida), NMM (near miss materno) e MM (morte materna) avaliou as complicações obstétricas decorrentes do aborto, as características socio-demográficas e obstétricas das mulheres, as condições de segurança do aborto e procedimentos médicos utilizados. Estimou-se a razão de prevalência ajustada pelo efeito de cluster do desenho e seus respectivos IC95%; uma análise múltipla por regressão logística foi utilizada para identificar os fatores independentemente associados à maior gravidade. Resultados: no inquérito epidemiológico obteve-se num total de 15542 mulheres uma prevalência de aborto espontâneo de 13,3% e de aborto induzido de 2,3% para todo o Brasil, estando ambos associados a um maior risco de morbidade materna grave. Os fatores relacionados ao maior risco de complicações foram a idade entre 40 e 49 anos, o número de filhos e de partos até um. As complicações mais comuns foram as hemorrágicas e infecciosas. No estudo multicêntrico, do total de 9555 mulheres, 2,5% apresentaram complicações secundárias ao aborto; dessas, 81,9% apresentaram CPAV, 15,2% NMM e 3% MM. A causa infecciosa foi a mais frequentemente associada ao aborto inseguro dentre os casos de CPAV. Os critérios de manejo foram mais importantes no aborto inseguro para os casos de NMM e MM. Na análise multivariada associaram-se à maior gravidade a presença de alguma demora e a ausência de companheiro. Conclusão: No Brasil o aborto é responsável por uma pequena porcentagem das complicações da gestação, porém as gestações terminadas em aborto apresentaram maior risco de complicações mais graves que aquelas terminadas em parto. Portanto há maior risco dessas complicações evoluirem desfavoravelmente para NMM ou MM / Abstract: Introduction: Still today abortion is associated with high rates of maternal morbidity and mortality. The maternal near miss, according to WHO (World Health Organization) it corresponds that woman who almost died but survived a complication during pregnancy, delivery or until 42 days postpartum, is currently understood as an important health indicator. However little is known on the association of near miss with abortion. Objectives: to evaluate the occurrence of spontaneous and induced abortion and its associated severe maternal morbidity, as referred by women in a population survey; to evaluate the occurrence of severe maternal complications associated with abortion in a study of prospective surveillance of cases of severe maternal morbidity in Brazilian referral centers. Methods: A first study was performed with a secondary analysis of data from the 2006 Brazilian DHS (Demographic Health Survey), with information from interviews on the experience of women on spontaneous and induced abortion, associated factors and complications corresponding of delivery and abortion. The occurrence of severe maternal morbidity associated with abortion was evaluated and a multiple analysis by logistic regression was used to identify the factors independently associated with both types of abortion. A second multicenter cross sectional study, with prospective surveillance of all cases of PLTC (potentially life threatening condition), MNM (maternal near miss) and MD (maternal death), evaluated the obstetric complications due to abortion, the socio-demographic characteristics of the women, safety for abortion and medical procedures used. The prevalence ratio adjusted by the cluster effect of the design was estimated together with their respective 95%CI, and a multiple analysis by logistic regression was used to identify the factors independently associated to higher severity. Results: in the epidemiological survey, from the total 15542 women, the prevalence of spontaneous abortion was 13.3% and of induced abortion was 2.3% for Brazil, and both were associated with a higher risk of severe maternal morbidity. The factors associated with the higher risk of complications were maternal age between 40 and 49 year and the number of children and deliveries until one. The commonest complications were hemorrhage and infection. In the multicenter study, from the total 9555 women, 2.5% had complications due to abortion; among them, 81.9% had PLTC, 15.2% MNM and 3% MD. Infection was the most frequent cause of unsafe abortion among cases of PLTC. The management criteria were more important for unsafe abortion among cases of MNM and MD. In the multivariate analysis the presence of any delay and the absence of a partner were associated with the higher severity of maternal morbidity. Conclusion: In Brazil abortion is responsible for a small percentage of complications of pregnancy, however those finished in abortion represent a higher risk of complications more severe than those finished in delivery. Therefore there is a higher risk of these complications having an unfavorable evolution to MNM or MD / Mestrado / Saúde Materna e Perinatal / Mestre em Ciências da Saúde

No abstract available. / Dissertation (LLM)--University of Pretoria, 2013. / gm2014 / Centre for Human Rights / unrestricted

Magister Curationis - MCur / The present study examined the extent of utilization of partogram among nurses and midwives in Rwamagana health facilities located in the eastern province of Rwanda. The study specifically sought to; assess knowledge and use of partogram among nurses and midwives in Rwamagana health facilities, to identify the challenges facing nurses and midwives with regards to the utilization of partogram in the health facilities and to determine factors influencing the use of partogram among nurses and midwives in Rwamagana health facilities. Patricia Benner’s model of nursing practice was used to guide this study

Magister Public Health - MPH / Introduction: The Health Extension Program (HEP) is an innovative, community based comprehensive primary health care program that Ethiopia introduced in 2003. It gives special emphasis to the provision of preventive and promotive services at community and household level. However, utilization of the HEP packages is low and reasons for this underutilization are not well known. Aim: The aim of this study is to assess the availability and utilization of the Health Extension Program Service in Akaki District of Oromia Region, Ethiopia. Methodology: Quantitative study using a cross-sectional survey design. The study was conducted in Akaki District of Oromia Regional State in Ethiopia with 79,162 inhabitants. Random sampling was used to select 355 households. A structured data collection tool/ questionnaire was employed to collect data from the study participants. Data were analyzed using SPSS for Windows version 19. Descriptive statistics were used to analyze socio demographic characteristics of the study participants and to assess the availability and utilization of each service component. Result: The response rate of the study was 100% with complete data obtained from 335 (94.4%) of the households. The majority (93.1%) of respondents were women. The availability of HEP services as described by the household visit of Health Extension Workers (HEWs) is very high with 86.6% visiting at least monthly and 11.3% visited sometimes. There was a highly significant association between the health extension workers’ visit to households and health extension service utilization during pregnancy (OR=16.913, 95% CI 8.074-35.427 at p<0.001). HIV testing utilization showed a tenfold increase among households who received education. Participation of households in the Model family initiative was another key factor associated with high levels of HEP services utilization. Conclusion and Recommendations: Though HEP services are available for most households, the frequency of household visits by HEWs and the involvement of Households in model family training greatly influenced service utilization. Improving frequency of services availability at household level and consistent health education will greatly improve services utilization.

Master of Public Health - MPH / Introduction: Despite the progress that Zambia has made in reducing its maternal mortality ratio from 649 to 398 per 100,000 live births between 1996 and 2013/14, the country did not meet the Millennium Development Goal 5a target, of reducing the maternal mortality ratio by 75% (i.e. to a ratio of 162 per 100,000 live births) by the end of 2015. Thus, as is the case with many other countries, considerable challenges still remain in relation to reducing maternal mortality in Zambia. According to Zambia's Roadmap for Accelerating Reduction of Maternal, Newborn and Child Mortality (2013-2016), the continuum of care for reproductive and maternal, newborn, and child health includes integrated service delivery for mothers and children across these various time periods, and also across place: within the home, the community, and in health facilities. In this regard, a referral system plays a key role in linking the various levels at which care is provided, and the different types of services offered at these levels. In the urban district of Lusaka, Zambia, all complicated pregnancy-related cases received by health centres or clinics are referred to either Levy Mwanawasa General Hospital, or the University Teaching Hospital. However, it appears that at present those working at the primary level of care, who make such referrals up to these higher levels of care, receive no feedback on the outcome of their referrals; there are also few counter-referrals to the respective clinics in the district. With limited communication to the primary level of care, and with no formal handover of patients back to the clinics by the tertiary level institutions, it is difficult to ensure that the required continuum of care for the referred mothers and their children, post-delivery, has been established within the district. This explorative study aimed therefore to identify the strengths and weaknesses of the maternity-related referral system currently operating between primary and tertiary levels of health care in the district, and to consider how the system might be strengthened so as to support a stronger continuum of care with respect to maternal and neonatal health. Methods: Using a descriptive qualitative research approach, stakeholders involved in the planning, delivery and/or oversight of maternal and neonatal health services in the district were purposively sampled and asked to voluntarily participate in the study. Prior to all the interviews, after being informed about the study, and receiving information sheets to read through, participants were required to give informed consent. Their experiences and opinions regarding referrals and counter-referrals were collected through a series of 23 individual, semi-structured interviews. A Thematic Analysis approach was used to analyse data in this study. Ethics approval was first obtained from the Senate Research Committee, University of the Western Cape and thereafter from the Excellence in Research Ethics and Science Converge Ethical Review Board in Zambia, before proceeding with the study. Clearance was also obtained from the Ministry of Health, the Lusaka District Health Management Team and the University Teaching Hospital to facilitate entry into the health facilities. Findings: The study found that, in practice, the referral system for maternity and neonatal health does exist and is generally – but not optimally - functional in the Lusaka District. However, challenges were noted that included the fact that the district’s maternity referral system has not been revised since it was first developed in the 1980s and is not available in a comprehensive set of guidelines or standard operational procedures which explicitly outline the reasons for referral and the related referral steps and mechanisms. In addition, the referral forms currently in use in the district have not been standardised and appear to be inconsistently used by the different facilities. Interviewees reported that there were limitations in terms of the number of, and availability of ambulances, and that there was also an inadequate number of trained midwives. Limitations on the health service's infrastructure, namely, the physical space that is available, the number of delivery beds, and the limited supply of equipment place an additional burden on the staff working at both the primary and tertiary level. Conclusion: Overall, the study recommends that further research – possibly in the form of a baseline audit – be conducted so as to develop a more detailed and/or operational assessment of the actual rather than the reported level of functionality of the district's maternity referral system. Specific recommendations are also proposed for the various stakeholders who are critical role players in the referral system, namely, the clinics, the University Teaching Hospital, the Lusaka District Health Management Team, the Provincial Health Office, the Ministry of Health and Cooperating Partners.

Model development for incorporating “indigenous” postnatal care into a midwifery healthcare system is of utmost importance in ensuring the provision of culturally congruent care. There has been only limited evidence of the availability of a model which addresses “indigenous” postnatal care practices in midwifery health care systems. As a result, the nurses operate from a modern healthcare point of view only, rather than combining the two worldviews. The main aim of the study was to develop a model for incorporating “indigenous” postnatal care practices into the midwifery health care system in Mopani District, Limpopo Province of South Africa. The study was conducted in three phases. During the first phase the meaning of the concept “incorporation” was analysed. The results guided the researcher during data collection in the second phase, consisting of in-depth individual and focus group interviews to explore the experiences and perceptions of postnatal patients, family members, traditional birth attendants, registered midwives, Midwifery lecturers and the maternal and child healthcare coordinators. The findings confirmed that currently the “indigenous” postnatal care practices are not incorporated in the Midwifery curriculum, books or guidelines for maternity care. As a result there is lack of knowledge amongst midwives regarding the “indigenous” postnatal care practices and it is difficult for them to provide culturally congruent care. Due to inadequate knowledge midwives are displaying negative attitudes towards the family members, traditional birth attendants and patients from diverse cultures. The participants confirmed that there is no teamwork between the registered midwives and the traditional birth attendants (family members). The study findings also confirmed that currently there are no follow-up visits by the midwives for patients during the postnatal period. The midwives are imposing their health beliefs an practices onto the patients on discharge after delivery, without the involvement of the family members or the traditional birth attendants, resulting in sub-standard postnatal care, leading to postnatal complications and an increasing maternal mortality rate. Based on the findings of phases one and two, a model for incorporating “indigenous” postnatal care practices into a midwifery healthcare system was developed and described. The implications for further studies suggested the evaluation and implementation of the model in the healthcare institutions, nursing colleges, clinics and hospitals as an initial step to assist the Department of Health in Limpopo Province in incorporating “indigenous” practices into healthcare systems. / Thesis (PhD)--University of Pretoria, 2012. / Nursing Science / unrestricted

Maternal mortality in Nigeria is one of the highest in the world. The rate is higher in the rural communities than in the urban. Given the complexity of causes of maternal mortality, it appears that the community is an important resource that is frequently overlooked. The contribution of which could be explored through collaboration with professional healthcare providers, to bring about reduction in maternal mortality. This study, proposed to empower members of the community to take action to prevent maternal mortality. Action research design was utilised, comprising cycles of fact-finding, planning/action, and evaluation with the aim of working towards a change in the status quo. In collaboration with the action research group, data were generated through 29 interviews, 8 focus group discussions and observation of 7 persons. Women of childbearing age were interviewed to gain understanding of their knowledge, attitude and practice towards maternal mortality. Focus group discussions were carried out with a cross section of the community. Observations were undertaken of skilled and traditional birth attendants (TBAs) in their places of practice. Altogether, there were 86 general participants and 12 action research group members in the study. Thematic data analysis and critical reflection were undertaken with emphasis on data which promote learning and change. The study revealed childbirth fallacies as evidenced in the causes of maternal deaths being attributed to superstitious beliefs. Other findings included religious beliefs/practices, birth practices, negative attitudes, lack of money, lack of transportation and health facilities issues as contributory factors. These findings were critically reflected upon by the action research group and actions based on the findings, aimed at empowering the people to take action to prevent maternal deaths were undertaken. The actions included community education, TBA training and development of a common forum between skilled birth attendants and TBAs. Participatory evaluation was undertaken from the perspectives of the participants to identify what made sense to them from the actions. Findings included some degree of empowerment and emancipation of the people evidenced in the acquisition of new knowledge which led to the repudiation of certain superstitious beliefs. Other findings include resumed utilisation of the service of skilled birth attendants at the local health facility by the women. The findings of this study have demonstrated implications for practice, policy and research to prevent maternal mortality in Bakassi LGA, Nigeria. Conclusion drawn is that, the community is an important resource which if mobilised through the process of action research, would be empowered to take action to prevent maternal mortality. The process will also foster the collaboration between skilled birth attendants and traditional birth attendants to improve maternal health care in the rural community.

Orientadores: João Paulo Dias de Souza, José Guilherme Cecatti / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T16:41:03Z (GMT). No. of bitstreams: 1 Chaves_SolangedaCruz_M.pdf: 1613021 bytes, checksum: 7d4197dbf48569d759c9b1315425c34b (MD5) Previous issue date: 2015 / Resumo: Objetivos: Avaliar se as características propostas da Transição Obstétrica ¿ um modelo conceitual criado para explicar as mudanças graduais que os países apresentam ao eliminar a mortalidade materna evitável ¿ são observadas em um grande banco de dados multipaíses sobre a saúde materna e perinatal.Métodos: Trata-se de análise secundária de um estudo transversal da OMS que coletou informações de todas as mulheres que deram à luz em 359 unidades de saúde de 29 países da África, Ásia, América Latina e Oriente Médio, durante um período de 2 a 4 meses entre 2010 e 2011. As razões de Condições Potencialmente Ameaçadoras da Vida (CPAV), Resultados Maternos Graves (RMG), Near Miss Materno (NMM), e Mortalidade Materna (MM) foram estimadas e estratificadas por estágio de transição obstétrica. Resultados: Dados de 314.623 mulheres incluídas neste estudo demonstram que a fecundidade das mulheres, indiretamente estimada pela paridade, foi maior nos países que estão em estágio menor da transição obstétrica, variando de uma média de 3,0 crianças por mulher no Estágio II para 1,8 crianças por mulher no Estágio IV. O nível de medicalização do nascimento nas instituições de saúde dos países participantes, avaliada pelas taxas de cesárea e de indução de trabalho de parto, tendeu a aumentar à medida que os estágios de transição obstétrica aumentam. No Estágio IV, as mulheres tiveram 2,4 vezes a taxa de cesáreas (15,3% no Estágio II e 36,7% no Estágio IV) e 2,6 vezes a taxa de indução de trabalho de parto (7,1% no Estágio II e 18,8% no Estágio IV) que as mulheres de países no Estágio II. À medida que os estágios da transição obstétrica aumentaram, a média de idade das primíparas também aumentou. A ocorrência de ruptura uterina apresentou uma tendência decrescente, caindo aproximadamente 5,2 vezes, de 178 para 34 casos para 100 000 nascidos vivos à medida que os países transicionaram do Estágio II para o Estágio IV. Conclusões: Esta análise corroborou o modelo da Transição Obstétrica utilizando um banco de dados de grande porte e multipaíses. O modelo da Transição Obstétrica pode justificar a individualização da estratégia de redução da mortalidade materna de acordo com os estágios da transição obstétrica de cada país / Abstract: Objectives: To test whether the proposed features of the Obstetric Transition Model¿a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality¿are observed in a large, multicountry, maternal and perinatal health database. Methods: This was a secondary analysis of a WHO cross-sectional study that collected information on all women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2¿4-month period in 2010 ¿ 2011. The ratios of Potentially Life-threatening Conditions (PLTC), Severe Maternal Outcomes (SMO), Maternal Near Miss (MNM) and Maternal Death (MD) were estimated and stratified by stages of obstetric transition. Results: Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. The level of medicalization in health facilities in participating countries, defined by the number of caesarean deliveries and number of labor inductions, tended to increase as the stage of obstetric transition increased. In Stage IV, women had 2.4 times the caesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) than women in Stage II. As the stages of obstetric transition increased, the mean age of primiparous women also increased. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. Conclusions: This analysis supports the concept of obstetric transition using multicountry data. The obstetric transition model could provide justification for customizing strategies for reducing maternal mortality according to a country¿s stage in the obstetric transition / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

La France se démarque par un ratio de mortalité maternelle par hémorragie du postpartum (HPP) élevé.Les objectifs de cette thèse étaient: 1/comparer les caractéristiques épidémiologiques de l'HPP entre la France et le Canada 2/décrire les pratiques d'anesthésie-réanimation dans l'HPP et évaluer leur adéquation par rapport aux recommandations chez les femmes décédées d'HPP et dans une population de femmes avec HPP.Les sources de données utilisées étaient: La base nationale canadienne de données hospitalières sur les séjours des patients, l'essai Pithagore6 et l'Enquête nationale confidentielle sur les morts maternelles.La comparaison du profil épidémiologique de l'HPP entre la France et le Canada montre que l'HPP n'est pas plus fréquente en France. Le recours plus fréquent à des traitements de seconde ligne suggère une incidence plus élevée de l'HPP sévère en France. Dans les décès maternels par HPP, certaines pratiques d'anesthésie-réanimation apparaissent comme inadéquates: le monitorage clinique et la mise en condition des patientes, la surveillance paraclinique, le protocole d'anesthésie générale et la stratégie transfusionnelle. La description en population des pratiques transfusionnelles dans l'HPP montre un recours insuffisant à la transfusion. Inversement des stratégies transfusionnelles dont l'efficacité n'est pas prouvée sont fréquemment appliquées.Ce travail suggère une sévérité importante de l'HPP en France, pouvant expliquer l'importance de la mortalité par HPP. Certaines pratiques d'anesthésie-réanimation apparaissant comme non-optimales pourraient être impliquées dans cette sévérité. L'association entre pratiques et sévérité de l'HPP reste à être étudiée. / In France, the maternal mortality ratio due to postpartum hemorrhage (PPH) is higher than in other high resources countries. This situation remains partially unexplained. The objectives of this PhD thesis were: 1/ to compare PPH epidemiological characteristics between France and Canada, 2/ to describe anesthesia and intensive care practices in PPH and to compare them with guidelines, first in cases of maternal deaths from PPH and secondly in a large population of women with PPH. The data sources were: the Discharge Abstract Database from the Canadian Institute for Health Information, the Pithagore6 trial and the French Confidential Enquiry into Maternal Deaths. The comparison of PPH epidemiological profiles between France and Canada shows that PPH incidence is not higher in France. Second-line treatments in PPH management are more frequently performed, suggesting a higher incidence of severe PPH in France. Among maternal deaths from PPH, some practices in anesthesia and critical care management appear to be inadequate: clinical monitoring and laboratory assessment, protocol for general anesthesia and transfusion strategy. The description on transfusion practices in a large population of women with PPH shows that the use of blood products is not sufficient. Conversely, transfusion strategies with unproved efficacy are frequently used. These results suggest a higher rate of severe PPH in France, that may result in the higher maternal mortality due to PPH. Inadequate practices in anesthesia and critical care could be involved in this severity. But the association between specific components of anesthesia and critical care management and PPH severity remains to be explored