PhD student: Hugo Madar

Title: Diagnostic markers and predictive factors for POST-PARTUM haemorrhage

Supervisors: Catherine Deneux-Tharaux & Loîc Sentilhes

Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité

Promotion: 2019

Funding: Hospital Practitioner Contract – CHU Bordeaux

Thesis abstract:

The incidence of postpartum hemorrhage is variable, ranging from 5 to 10% of deliveries. This great variability is partly explained by the absence of a consensual definition of “post-partum hemorrhage”. For most guidelines, postpartum hemorrhage is defined as blood loss of 500 mL or more in the 24 hours following delivery, but the choice of this threshold is still the subject of debate. Moreover, the other pitfall of the classic definition of postpartum hemorrhage is that the variable method of assessing blood loss largely determines the result, and therefore the reported incidence of postpartum hemorrhage.

A number of risk factors for post-partum hemorrhage, particularly uterine atony (the main cause of PPH), have been identified but their predictive relevance in the occurrence of PPH has not been studied. Among these risk factors, some are pre-existing pregnancy characteristics (parity, body mass index, history of hemorrhage, etc.), others are pregnancy-related (twin pregnancy, fetal macrosomia, etc.), and some depend on the mode of delivery (duration of labor, dose of oxytocin, etc.). From a clinical point of view, a predictive approach to post-partum hemorrhage could be useful both before delivery, to anticipate the place of delivery (prediction of severe PPH), and just after delivery, to be ready to rapidly implement treatment in the event of abnormal bleeding.

Thus, given the frequency and risks of PPH for maternal health, it remains necessary to improve knowledge concerning its diagnostic markers and the predictive factors of its severity, which constitutes the overall aim of this thesis project in the form of 2 distinct objectives:

1/ To compare the distribution of postpartum blood loss after vaginal delivery assessed by two methods — quantitative blood loss (QBL) and calculated blood loss (CBL) — and the incidence of abnormal blood loss with each from the merge database of TRAAP, TRACOR and CYTOCINON studies.

2/ To describe the Shock Index (SI) distribution during the first 2 hours after vaginal delivery and to evaluate the performance of SI, measured at 15 and 30 minutes after delivery, in predicting postpartum hemorrhage occurrence from the database of TRAAP study.


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