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

Gilbert, T., Smulian,
J., Martin, A.,
Ananth, C., Scorza,
W. & Scardella, A.
(2003)
Cheng, C. &
Raman, S. (2002)
kCE Reports 94 Maternal Intensive Care in Belgium 123
12 USA (New
Jersey)
233
obstetric
patients
admitted to
the medical
ICU
13 Singapore 43 obstetric
admissions
to the
surgical ICU
A retrospective tertiary centre based
analysis of the medical records of
consecutive obstetric admissions to
the medical ICU from 1991 to 1998.
Two investigators reviewed the
charts by the means of abstraction
forms, the abstracted data included
demographics, past medical history,
prenatal history, delivery data,
indications for ICU transfer,
physiologic parameters SAPS II, ICU
complications, hospital length of stay
and death during hospitalization.
Patients are grouped by antepartum
or postpartum status and by admitting
diagnosis.
The SAPS is tested within an obstetric
population.
A retrospective tertiary centre based
review of all obstetric admissions to
the Surgical Intensive Care Unit of
the Singapore General Hospital.
Admission records were used to
identify all patients admitted to the
SICU from 1994 to 1999, either
pregnant or in the immediate
Retrospective
tertiary
centre based
analysis of
obstetric
admissions to
the general
ICU
Retrospective
tertiary
centre based
analysis of
obstetric
admissions to
the surgical
ICU
often require minimal intervention and are associated
with low mortality rates. Many might be more
appropriately managed in an HDU. The commonly used
severity of illness scoring systems are good
discriminators of outcome from intensive care admission
in this group but may overestimate mortality rates.
Severity of illness scoring systems may require
modification in obstetrical patients to adjust for the
normal physiologic responses to pregnancy.
OBJECTIVE: To determine whether mortality
prediction based on a current model of outcome
prediction is accurate in obstetric patients.
RESULTS: The Simplified Acute Physiologic Score
overestimated mortality in all patients (19 predicted
deaths, eight observed) but accurately predicted
mortality in patients admitted to the intensive care unit
for medical reasons (seven predicted, five observed).
The Simplified Acute Physiologic Score did not predict
mortality in patients admitted for obstetric indications or
postpartum hemorrhage. Median SAPS II scores were
significantly higher in those patients who died, compared
with survivors. For all groups, SAPS II scores were
correlated with intensive care unit length of stay but not
hospital length of stay.
CONCLUSION: The Simplified Acute Physiologic
Score accurately predicts hospital mortality in obstetric
patients admitted to the intensive care unit for medical
reasons but not for indications related to pregnancy and
delivery. An alternate model that predicts outcomes in
obstetric patients admitted for obstetric indications
should be developed.
OBJECTIVE: This study was performed in order to
determine the obstetric complications occurring in a
tertiary hospital in Singapore and review the outcome of
the patients who were admitted to the intensive care
unit.
RESULTS: There were 43 obstetric admissions during
this period, with 38 deliveries. This represents 0.32% of
the deliveries in this hospital during the study period.
1+
2+
3+
4+
5+
6+/-
7+
8+
9+/-
10-
Score:+
1+/-
2+/-
3+
4+/-
5?
6?
7?
8+
3
3