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

Lapinsky, S.,
Kruczynski, K.,
Seaward, G.,
Farine, D. &
Grossman, R.
(1996)
kCE Reports 94 Maternal Intensive Care in Belgium 117
4 Canada 65 obstetric
patients
admitted to
the ICU
interventions and clinical outcome
were analysed. They examined
whether admission could have been
predicted and assess future
requirements for intensive care and
high dependency nursing.
A retrospective chart review was
performed of obstetric patients
admitted to the intensive care unit of
an academic hospital with a high-risk
obstetric service (~MIC), during a
five-year period (1990-1994). Data
obtained included (i) clinical
information: demographic data,
obstetric history, details of the
current pregnancy, past medical
history and the presenting problem;
(ii) ICU data: indication for ICU
admission, length of stay and
procedures performed;
(iii) laboratory data: on admission to
ICU and during ICU stay; (iv)
maternal and fetal outcome, and (v)
daily APACHE II scores and
Therapeutic Intervention Scoring
System (TISS) scores. Patients were
stratified further into two groups:
those with a medical condition
(Medical group) or an obstetric
complication (Obstetric group), to
patients
admitted to
the ITU
Retrospective
tertiary
centre based
chart review
of obstetric
patients
admitted to
the ICU
compared with high dependency nursing.
RESULTS: The majority of women (67%) had no preexisting
medical or obstetric history. The major
indications for admission were hypertensive disease of
pregnancy (66%) and haemorrhage (19%); 79% followed
caesarean section and 40% required ventilatory support.
The perinatal mortality rate was 6% and there were
three maternal deaths.
CONCLUSION: The need for admission to ITU was
unpredictable in two-thirds of the cases. Many of the
women evaluated in this review were ineligible for high
dependency care and required full ITU facilities, both of
which will always be needed to deal with serious
complications of pregnancy.
OBJECTIVE: To review a series of critically ill
obstetric patients admitted to a general intensive care
unit in a Canadian centre, to assess the spectrum of
diseases, interventions required and outcome.
RESULTS: Sixty-five obstetric patients, representing
0.26% of deliveries in this hospital, were admitted to the
ICU during the study period. All had received prenatal
care. Admission diagnoses included obstetric (71%) and
nonobstetric (29%) complications. The mean APACHE II
score was 6.8 ± 4.2 and mean TISS score was 24 ± 8.1.
Twenty-seven patients (42%) required mechanical
ventilation. No maternal mortality occurred and the
perinatal mortality rate was ! I %.
CONCLUSIONS: A small proportion of obstetric
patients develop complications requiring ICU admission.
The outcome in this study was excellent, in contrast to
that reported in other published studies with similar ICU
admission rates. The universal availability of prenatal care
may be an important factor in the outcome of this group
of patients. The lack of a specific severity of illness
scoring system for the pregnant patient makes
comparison of case series difficult.
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