The confidential enquiries into maternal deaths, 1996-2006 in France: What consequences for the obstetrical care?

The national confidential enquiry into maternal deaths (ENCMM) and its committee (CNEMM) have the target to study all maternal deaths occurring in France, in order to expertise the care provided. The current report covers the 1996 year of the ENCMM establishment to 2006 years. After being informed of the potential maternal deaths by the Epidemiological center on medical causes of deaths (CepiDC), and agreement from the medical doctors concerned, two assessors (one anesthetist and one obstetrician) gather the medical or obstetrical information near the team involved in the care of the women, by the mean of a detailed and specific questionnaire. The completely anonymous files are expertised by the CNEMM. Maternal mortality rates have been calculated by periods, the distribution of the obstetrical causes and the characteristics of the dead women were calculated too. The substandard care and the avoidability of deaths were estimated by subgroup. Since 1996 to 2006, 729 maternal deaths were included of which 553 were expertised. The majority of maternal deaths were due to direct obstetrical causes (73%) mainly haemorrhages (22%), amniotic fluid embolism (12%), complications of hypertension (10%), and venous thrombo-embolism (around 10% each). Half of maternal deaths were considered preventable by the CNEMM, particularly haemorrhage and sepsis. The factors of avoidability are delay to treat (31%) inadapted therapeutics (28%), even professional default (20%) no diagnosis (15%) or reluctant patient (7%). Seven deaths are discussed in a specific section including a detailed description of, and recommendations on how the quality of care may be improved. (C) 2010 Elsevier Masson SAS. All rights reserved.