Are invasive therapies for primary post-partum haemorrhage effective?

We will discuss “Invasive therapies for primary postpartum haemorrhage: a population-based study in France.” by Kayem and co-workers from 28 October 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 19 October 2015.

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Start date: 28 October (the discussion will open for 7 days between 28 October to 4 November 2015)

First hosted discussion session(s) starts at: GMT 7pm (UK time- please note the clock changes on 24 October)

Host: @BlueJCHost

Platforms: TwitterLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

Scenario

During a multidisciplinary training day on the management of post-partum haemorrhage (PPH), a number of invasive therapies were described. One of the delegates asked, “how often are these invasive therapies used? Are they effective?”.

Description of research

Participants Women who have participated in the PITHAGORE6 trial (106 maternity units in 6 French regions) and developed primary PPH between December 2004 and November 2006
Intervention Invasive therapies for PPH, including uterine suture, pelvic vessel ligation, arterial embolisation and hysterectomy.
Comparison National databases in the UK and Netherlands
Outcomes Maternal mortality, hysterectomy rate, incidence of conservative invasive therapies and their failure rates
Study design Observational study (retrospective analysis of a large clinical trial cohort)

Discussion Points

  • In your local practice, how often are invasive therapies used to manage PPH? Moreover, what is the most frequently used invasive therapies for PPH?
  • What are the advantages and disadvantages of a retrospective analysis of large clinical trial datasets compared to a prospective population-based surveillance programme?
  • How may a prospective population-based surveillance programme further improve the quality of the data collected in this study?
  • How do maternal mortality and morbidity rates from PPH in France compared to those in the UK and Netherlands (see Table 4)?
  • Which factors may have caused the observed differences in maternal mortality and morbidities?
  • Did the results of the current study support the authors’ conclusions?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle M, Rudigoz R. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG 2010;117:1278–1287.
  • Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez-Medina D, Barber R, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Sep 13;384(9947):980-1004.
  • Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG. 2014 Mar;121(4):382-8.

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