[Quality of perinatal statistics from hospital discharge data: comparison with civil registration and the 2010 National Perinatal Survey]. / Qualité des données périnatales issues du PMSI: comparaison avec l'état civil et l'enquête nationale périnatale 2010.

OBJECTIVE: To compare hospital discharge data (PMSI) with data in the reference databases: vital statistics and National Perinatal Surveys (NPS) for the principal perinatal indicators. METHODS: Data concerning hospitalizations for delivery and childbirth were extracted from the PMSI 2010 database. The exhaustiveness was assessed by comparing discharge data with data from birth certificates. Indicators were compared with those in the 2010 NPS, which was based on a representative sample of births (n=15,000), using 95% confidence intervals. RESULTS: About 823,360 hospital abstracts with delivery and 829,351 hospital abstracts with live births were considered. The exhaustiveness of the PMSI was 99.6% for live births in Metropolitan France. The distribution of maternal age, mode of delivery, birth weight and gestational age in the PMSI and NPS were very similar. In Metropolitan France, the prematurity rate was 6.9% (PMSI) vs. 6.6% [6.2-7.0] (NPS) and the rate of caesarean was 20.6% vs. 20.4% [19.8-21.1]. There were marked differences for the percentage of birth weights<2500g and for maternal diseases. CONCLUSION: The routine use of the PMSI for some indicators for follow-up purposes is foreseeable. Validation studies are still necessary for maternal diseases, for which recording is less standardized.

[French modalities of myocardial revascularisation in 2001]. / Modalités de la revascularisation myocardique en France en 2001.

UNLABELLED: French modalities of myocardial revascularization were unknown, whereas beneficial effect on outcome was controversial. The study describes current practices in 2001 and analyzes those data according to regional coronary heart disease incidence and mortality. METHODS: Data are obtained from the French hospital national database (PMSI). Mortality is obtained from French mortality registry, and myocardial infarction incidence is estimated with French registries of MONICA project. RESULTS: Myocardial revascularization utilization fluctuate from 25% of patients hospitalized for coronary disease in Limousin to more than 40% of patients in Provence-Alpes-Côte d'Azur (PACA), Languedoc-Roussillon and Ile-de-France. Standardized rate per 100,000 individuals is 109 in Pays de la Loire and 309 in Corse. Medical care offers seem to influence the practice. In the six regions where the rates are the lower, the density of interventional unit and on-pump center are below the national average, and the cardiologist density is very low. Consequences on regional clinical outcome of coronary heart disease are discussed based on mortality rate and levels of evidenced based medicine in myocardial revascularization. CONCLUSION: For the first time, we describe a wide variation of regional practices for myocardial revascularization in France. A part of those variations can be attributed to regional differences in medical care offers. Finally, the impact on clinical outcome appears clearly but seems limited. Cardiovascular prevention strategy remains of first line importance and emphasizes this main mission of cardiologists.

[Emergency haemostasis hysterectomy in obstetrics]. / Les hystérectomies d'hémostase d'urgence en obstétrique.

The study was based on 15 cases of haemostasis hysterectomy: 7 cases after caesarian section, 8 cases after normal delivery. The etiological circumstances varied, the haemorrhage being due to uterine rupture, to an accident during delivery related to uterine atony, to placenta accreta, or to a coagulation disorder. In these circumstances, the most satisfactory operation seems to be total hysterectomy with bilateral ovariectomy, conservation of the ovaries being justified in younger women. The authors describe the precautions that they feel are essential during labour or during a caesarian section to avoid such complications.