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

Bewley, S. &
Creighton, S.
(1997)
Mahutte, N.,
Murphy-Kaulbeck,
L., Le, Q.,
Solomon, J.,
Benjamin, A. &
Boyd, M. (1999)
118 Maternal Intensive Care in Belgium KCE Reports 94
5 UK 30 obstetric
transfers to
the ITU
6 Canada 131
obstetric
ICU
admissions
assess the role of the precipitating
condition on severity of illness
scoring, ICU procedures
and outcome.
Retrospective review of all hospital
records from 30 obstetric women
transferred from University College
Obstetric Hospital (UCU) to the
intensive care unit (ITU) over a twoyear
period (1991-1992). Details of
antecedent risk factors, labour and
delivery, date and time of transfer,
length of stay, principal reason for
transfer, relevant subsidiary problems
and interventions were recorded.
Retrospective analyse of all obstetric
admissions to the ICU at two tertiary
care centers (McGill University
Hospitals) from 1991 to 1997. Data
collected included maternal age,
gestational age, pre-existing medical
problems, diagnoses, the Acute
Physiology and Chronic Health
Evaluation II score, and specific
interventions and outcomes in the
ICU.11 The patients’ critical illnesses
(eg, hemorrhage) and the
complications that prompted ICU
Retrospective
tertiary
centre based
review of all
hospital
records of
obstetric
patients
admitted to
the ITU
Retrospective
tertiary
centre based
analysis of all
obstetric
admissions to
the ICU
OBJECTIVE: A near-miss maternal mortality enquiry
was performed at University College Obstetric Hospital,
London.
RESULTS: The obstetric admission rate to ITU was
0´5 (95% CI 0´32±0´67%), or one per 200 women
delivered. Haemorrhage and severe pre-eclampsia were
the two commonest causes of admission. Sub-standard
care was identified in 52% of cases. Blood loss was often
massive (> 2000 ml), underestimated and required large
volume transfusions (mean transfusion 6´4 units, range
1±24). Although there are problems with definitions,
ascertainment and validity, ` near-miss’ review is feasible.
It is worthwhile for every hospital to carry out its own `
near-miss’ enquiry using appropriate local criteria to
identify potential areas for improvements.
CONCLUSIONS: `Near-misses’ are more prevalent
than deaths and are dominated by conditions that are
amenable to treatment. They may be even more
sensitive to improvement or deterioration in obstetric
services than mortality data.
OBJECTIVE To determine whether obstetric
admissions to the intensive care unit (ICU) are useful
quality-assurance indicators.
RESULTS: The 131 obstetric admissions represented
0.3% of all deliveries. The majority (78%) of women
were admitted to the ICU postpartum. Obstetric
hemorrhage (26%) and hypertension (21%) were the
two most common reasons for admission. Together
with cardiac disease, respiratory disorders, and infection,
they accounted for more than 80% of all admissions.
Preexisting medical conditions were present in 38% of all
admissions. The median Acute Physiology and Chronic
Health Evaluation II score was 8.5. The predicted
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Score:+/-
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Score:+/-
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