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

Heinonen, S.,
Tyrvaïnen, E.
Saarikoski, S. &
Ruokonen, E.
(2002)
114 Maternal Intensive Care in Belgium KCE Reports 94
42 Finland 22 consecutive
obstetric patients
admitted to a
mixed
medical/surgical
ICU
anaesthetist but normally
completed by a consultant
responsible for obstetric
anaesthesia. The researcher
wanted, in succession of the
recommendations in the
Confidential Enquiries Mat. Death
asses postoperative recovery, HD
and IC facilities, monitoring
equipment, blood banks and
anaesthetic staffing. Results were
reported in relation to their
number of deliveries (small or large
units)
A retrospective cross-sectional
study of intensive care admissions
in Kuopio University Hospital from
march 2003 to October 2000.
Demographics, admitting diagnoses,
APACHE II score, clinical
outcomes and treatment costs
were recorded. Women admitted
to the ICU between 18 weeks
pregnancy and 4 weeks postpartum
were included. Each case requiring
IC was classified according to the
marker of severe acute maternal
morbidity, the primary obstetric
factor and any organ dysfunction or
failure. Similarly information about
length of stay in the ICU, specific
interventions and overall outcome
of all patients was recorded. TISS
(therapeutic intervention scoring
system) was used to do an
Retrospective
tertiary based
review of all
obstetric patients
treated on the ICU
at Kuopio
University Hospital
equipment, blood banks and anaesthetic
staffing.
RESULTS: The results show that although
many units had achieved recommended
standards, this was not universal. In
particular, only 62% had a designated and
staffed recovery area, only 41% had specific
obstetric high dependency beds and there
were a number of units with no consultant
anaesthetic sessions or trained anaesthetic
assistants available around the clock..
CONCLUSIONS: Despite the practical
and financial difficulties in achieving
recommended standards, it should be noted
that purchasers of health care have been
encouraged to ensure that the
recommendations are implemented.
OBJECTIVE: The purpose of the study was
to note potential obstetric risk factors
leading to maternal intensive care and to
estimate the frequency, costs and outcomes
of management.
RESULTS: the overall need for maternal
intensive care was 0,9 per 1000 deliveries
during the study period. The mean age of the
patients was 31,7 years and the APACHE
score 10,8. The most common admission
diagnoses were obstetric haemorrhage (73%)
and pre-eclampsia-related complications
(32%). The duration of ICU stay was 5,8 days
and one of the 21 patients died in the ICU
(4,5%). The total cost of IC was in order of
5000 US $ per patient.
CONCLUSION: Very few obstetric
patients develop complications requiring
intensive care. Although severel risk factors
associated with maternal intensive care were
documented, most cases occurred in low-
9?
10-
Score:ok
1+
2+
3+
4?+/-
5+/-
6?
7?
8+
9+/-
10-
Score:ok
3