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

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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 1+/- 2+ 3+ 4? 5? 6? 7? 8+ 9+ 10- Score:+/- 1+ 2+ 3+ 4? 5+/- 6? 7? 8+ 9+/- 10- Score:+/- 3 3
Cohen, J., Singer, P., Kogan, A., Hod, M, & Bar, J. (2000) kCE Reports 94 Maternal Intensive Care in Belgium 119 7 Israel 46 obstetric patients admitted to the ICU admission were recorded separately. Complications prompting ICU admission were categorized as hemodynamic instability, respiratory compromise, or neurologic dysfunction. Disease cofactors such as adult respiratory distress syndrome; multiorgan failure; hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; and disseminated intravascular coagulation (DIC) were also examined. Length of time in the ICU, specific interventions, and outcomes were recorded. Mechanical ventilation, central and arterial monitoring, transfusion of blood products, and vasoactive infusions (eg, norepinephrine, dopamine) also were noted. A retrospective case series study was performed including all pregnant patients admitted to an 8-bed general intensive care unit at a tertiary care university-affiliated hospital (Rabin Medical Centre) over a 4-year period (1994-1998). All patients referred by the obstetricians were admitted. The files of all patients were reviewed. Patients were divided into two groups: group 1, (n½19) those requiring mechanical ventilatory support and group 2, (n½27) those requiring intensive monitoring. Data collected included demographics, reason for admission, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Retrospective tertiary centre based case series study of all pregnant patients admitted to a general ICU mortality rate for the group was 10.0%, and the actual mortality rate was 2.3%. CONCLUSION: The most common precipitants of ICU admission were obstetric hemorrhage and uncontrolled hypertension. Improved management strategies for these problems may significantly reduce major maternal morbidity.. OBJECTIVE: To characterize the course, interventions required to achieve predetermined endpoints and outcome of obstetric patients admitted to a general intensive care unit. RESULTS: Over the study period, 46 obstetric patients were admitted to the intensive care unit, representing 0.2% of all deliveries and an intensive care unit utilization rate of 2.3%. Commonest admission diagnoses were pregnancy-induced hypertension and hemorrhage. Reason for admission was mechanical ventilation in 41% while 59% were admitted for monitoring. Median length of stay was 25º80.9 (mean 48.8) hours. The median APACHE II score was 6º3.9 (mean 7.24) and the TISS score was .20 in both groups. Only one patient died (mortality rate 2.3%). CONCLUSION: Despite a short length of stay and low APACHE score, the high TISS score in obstetric patients admitted for both ventilation and monitoring suggests that these patients require a level of 1+ 2+ 3+ 4+ 5+ 6? 7+ 8+ 9+/- 10- Score:ok 3
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