Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

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Meerman, R.H., Harinck, B.I.J., Feuth, H.D.M. & van Roosmalen, J. (2006) Zeeman, G. (2006) 106 Maternal Intensive Care in Belgium KCE Reports 94 4 The Netherlands Leiden University Medical Centre (1991-2001) of all obstetric admissions to the multidisciplinary ICU 1990-2001. Post-operative recovery women were excluded. Data on: diagnosis at the time of ICU admission, therapeutic interventions, maternal outcome, perinatal mortality and length of ICU and hospital stay. Special attention was given to the relation between ICU admission and ethnic background (Caucasian or not-Caucasian). Focuses on several important disorders of critically ill obstetric patients and reviews issues of respiratory failure in pregnancy. / Literature review of 30 articles (last 15 years) describing characteristics and treatment of critically ill pregnant or puerperal women. Items like the lack of ICU scoring systems for critically ill obstetric patients, obstetric highdependency care unit (and the indications for intermediate and ICU-care), maternal morbidity as indicator for quality of care, preeclampsia, hemorrhage and who cares for the critically ill obstetric patient are discussed. based analysis of medical records of all obstetric admissions ICU (syst.) literature review Intensive Care Unit (ICU) during pregnancy, childbirth or puerperium. RESULTS: Over these 12 years, 142 women required ICU admission (0.76% of all deliveries, 0.70% of all adult ICU admissions). The most common reasons for ICU admission were (pre)eclampsia (62.0%) and obstetric haemorrhage (18.3%). Twentyseven out of 142 women (19.0%) were of non-caucasian origin. The most common therapeutic interventions were transfusion of erythrocytes (66.2%), caesarean section (50.7%) and artificial ventilation (44.4%). We observed seven maternal deaths (4.9%). CONCLUSION: We need better information about high-risk obstetric patients in order to prevent severe maternal morbidity and to improve maternal care. The high number of non-caucasian women requiring ICU admission indicates the need for a study into the role of ethnicity. We have initiated a nationwide confidential enquiry into the causes of severe maternal morbidity. OBJECTIVE: The purpose of this review is two-fold: first, to provide an update on currently available reports pertaining to important critical care issues of the obstetric patient population and, second, to present current comprehensive treatment options for preeclampsia and massive obstetric hemorrhage because both are responsible for the majority of maternal mortality and morbidity worldwide. RESULTS: The most common reasons for intensive care unit admission are hypertensive disorders and massive obstetric hemorrhage. Timely delivery and prompt 3+ 4+ 5+ 6+ 7? 8+ 9+ 10? Score:ok 1+ 2? 3+/- 4? 5? 6+ 7nvt Score: twijfel-achtig 3
Fowler, S.J. (2005) kCE Reports 94 Maternal Intensive Care in Belgium 107 9 New Zealand (Wellington) 240 (76,4%) hospitals (Inter)nationwide (Australia & New Zealand) retrospective health care survey of all units that offer operative obstetric services. Hospitals with fewer than 50 deliveries per year and military hospitals were excluded. Postal questionnaires concerning major obstetric haemorrhage management have been send to all Australian & New Zealand operative obstetric services. An assessment of facilities relevant to International retrospective health care survey of operative obstetric services initiation of antihypertensive therapy for severe hypertension form the mainstay of care in preeclampsia. Restoration of circulating blood volume and rapid control of bleeding and impaired coagulation are the main factors in the management of massive obstetric hemorrhage. Puerperal morbidity has become the main topic of quality of care issues in maternity care. Although the Acute Physiology and Chronic Health Evaluation II score is commonly used in the intensive care unit, it does not seem to be appropriate for pregnant women because it overestimates their mortality rates. A high-dependency care unit suits the needs for at least half of the obstetric patient population in need of higher acuity care and will save considerable cost. CONCLUSION: Emphasis on early detection of maternal problems and prompt referral to tertiary centers with intensive care unit facilities to provide optimum care of the circulation, blood pressure, and respiration at an early stage could minimize the prevalence of multiple organ failure and mortality in critically ill obstetric patients. OBJECTIVE: The aim of this study was to assess facilities relevant to major obstetric haemorrhage management in all units in Australia and New Zealand that offer operative obstetric services RESULTS: Responses were received from 240 (76.4%) of the 314 hospitals surveyed (187 public and 53 private). One hundred and nine units (45%) had fewer than 500 deliveries per year (a lot of small facilities). Distances to referral facilities were frequently very large. Of the 90 hospitals (38.1%) without an onsite blood bank, 12 did 1+ 2+ 3+ 4? 5? 6+ 7-? 8+ 9+ 10? Score:ok 3
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