Maternal deaths in France: Management by emergency departments

In France, 272 maternal deaths occurred during the period 2016 - 2018, of which 131 were initially treated by healthcare professionals not specialized in obstetric. Fifty-six fi les were excluded because they did not concern emergency services or because there was insuf fi cient data to allow analysis. Seventy- fi ve cases of maternal deaths initially treated by emergency services [inhospital emergency department (ED) or emergency medical ambulance (SAMU)] were analyzed. Fifty-six cases were treated by the SAMU and 22 by an ED (both in 3 cases). The causes of death were 20 cardiovascular events, 18 pulmonary embolisms, 9 neurological failures and 8 hemorrhagic shocks. The event occurred during pregnancy in 48 cases (64%) and during per- or postpartum period in 27 cases (36%). The motivations for consultation at the ED were mainly pain ( n = 9), respiratory distress ( n = 6) or faintness ( n = 3). The reasons for calling emergency dispatching service (SAMU) were cardiorespiratory arrest in 32 cases (57%) and neurological failure (coma or status epilepticus) in 6 cases (11%). Among the 56 patients treated outside the hospital, 17 died on scene and 39 were transported to a resuscitation room ( n = 13), a specialized department ( n = 13), an obstetrics department ( n = 8) and less often in the ED ( n = 2). This was considered appropriate in 35 out of 39 cases (90%). Concerning the 75 fi les analyzed (ED and SAMU), death was considered unavoidable in 37 cases (49%) and potentially avoidable in 29 cases (38%) (maybe = 23, probably = 6). Avoidability could not be established in 9 cases. Among the 29 potentially avoidable deaths (38%), one of the criteria of avoidability concerned emergency services in 14 cases (ED = 9, SAMU/SMUR = 5, 18% of the fi les studied). ED's cares were considered optimal in 11 cases (50%) and non -optimal in 11 cases (50%). SAMU's cares were considered optimal in 45 cases (80%).