In 2012, infant mortality in Seine-Saint-Denis stood at 4.8 per thousand live births against 3.2 in mainland France. The audit of perinatal and neonatal deaths, funded by the Regional Health Agency (ARS-IDF) as part of the RéMI project (Reduction of Infant and Perinatal Mortality) made it possible to formulate hypotheses on the reasons for this discrepancy. : unfavorable living conditions, poorer health status of the population, inadequate pregnancy monitoring and difficulties in coordinating care.
During 2014, 249 deaths were reported in maternity hospitals in Seine-Saint-Denis: 172 stillborn babies and 77 neonatal deaths. the report prepared by the National Institute of Health and medical research (Inserm), teaches us that this infant mortality is characterized by a large proportion of very premature births linked to infections, vascular pathologies (27%) or without an identified cause (36%).
The causes of this excess mortality
- Communication difficulties are often noted in medical files: 15% of women would need an interpreter and some do not understand the doctor’s or midwife’s instructions (problems of incomprehension were noted in 9% of files).
- Refusal to attend several consultations, refusal of hospitalization, prescribed examinations not done, treatments not taken: these so-called “non-compliance” problems were noted in a quarter of the files. During the interviews, difficulties in making an appointment or in going to the appointments and the problems of financing of the care were reported by half of the women.
- 50% of women were overweight or obese or body mass index (BMI) too high has an impact on the risk of perinatal and neonatal mortality. And these women often have a care path that is unsuitable for their pathology (especially in cases of diabetes or hypertension)
All these observations allowed specialists to conclude that 33% of deaths could probably have been avoided.
How to reduce the number of deaths
In the light of these figures, the Regional Health Agency proposes priority axes to try to reduce the gap with the other departments of the region:
- The identification and early referral of pregnant women to appropriate structures in the event of a history or chronic illnesses.
- Prevention of risks associated withobesity and overweight
- Strengthening the coordination of care, especially for pregnant women with pathologies or multiple risk factors. Innovative approaches could be considered: for example the use of social networks to make reminders of appointments or treatment or the designation of a “contact person” who could help women at risk to follow an optimal course. .
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