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

Schatz et al ( 15
bis
kCE Reports 94 Maternal Intensive Care in Belgium 109
USA 1739 pregnant
asthmatic
patients, < 26
weeks gestation
all births in basic and
comprehensive EmOC facilities,
met need for EmOC: proportion of
women estimated to have
complications who are treated in
EmOC facilities, caesarean section
as percentage of all births in the
population and case fatality rate in
EmOC. All these indicators are
compared to the minimum
acceptable level recommended by
WHO/UNICEF/UNFPA.
Prospective observational cohort
study from 1994-1999 in 16
Maternal-Fetal Medicine Units. This
study evaluates the relationship
between asthma severity
classification (1993) during
pregnancy and gestational asthma
exacerbations. 873 pregnant
patients with mild asthma, 814
moderate & 52 severe asthma
patients were included. Participants
were excluded for known multiple
gestation, intrauterine fetal demise,
major congenital abnormalities,
active pulmonary disease other
than asthma, inability to schedule
an ultrasound for gestational age
confirmation, or gestational age
greater than 25 weeks and 6 days
at intake.
All obstetric patients were asked
for physician diagnosed asthma.
Information regarding symptom
frequency, asthma medication use,
Prospective
observational
cohort study
combined case-fatality rate in the
basic/comprehensive EmOC facilities was
1.7%. Major obstetric complications
contributed to 85.7% of maternal deaths, and
pre-eclampsia/eclampsia was the most
common cause.
CONCLUSION: It can be concluded that
all the process indicators, except proportion
of deliveries in the EmOC facilities, were
below the acceptable level. Certain priority
measures, such as making facilities fully
functional, effective referral and monitoring
system, skill-based training, etc., are to be
emphasized to improve the situation.
OBJECTIVE: The objective of this study
was to evaluate the relationship between
asthma severity classification during
pregnancy and gestational asthma
exacerbations.
RESULTS: Initial asthma classification (mild,
moderate, or severe) was significantly related
to subsequent asthma morbidity during
pregnancy (hospitalizations, unscheduled
visits, corticosteroid requirements, and
asthma symptoms during labor and delivery).
Exacerbations during pregnancy occurred in
12.6% of patients initially classified as mild,
25.7% of patients classified as moderate, and
51.9% of patients classified as severe (P <
.001). Asthma morbidity was similar, whether
patients were classified as moderate or
severe by symptoms and spirometry or by
medication requirement. Thirty percent of
initially mild patients were reclassified as
moderate-severe during pregnancy, and 23%
of the initially moderate-severe patients were
reclassified as mild later in pregnancy; asthma
morbidity in these patients changed
1+
2+
3+
4+/-
5+
6+/-
7?
8+
9+/-
10-
Score:ok
3