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

KCE Reports 94 Maternal Intensive Care in Belgium 5
1 INTRODUCTION
1.1 SCOPE OF THIS REPORT
The goal of this report is:” To describe the current performance of the MIC-services in
Belgium in order to formulate propositions of efficient utilization of these services”.
It is important to point out that the concept ‘Maternal Intensive Care’ in Belgium is
understood as a level of intermediate care. The MIC-services in Belgium are not
Intensive Care Units (cf. following definition), specialized in peripartum complications.
MIC-services provide a level of care between standard and intensive care. Therefore in
this report we use the less confusing concept ‘Maternal Intermediate Care (MIC)’ to
refer to intermediate care provided to peripartal women in Belgium.
1.2 BACKGROUND
In Belgium, the Maternal Intensive Care (MIC) concept was introduced by law in 1996.
The Royal Decree (RD) of Augustus 20 th 1996 defines Maternal Intensive Care as
follows: “The MIC-service
1
is recognized as a division of the maternity department (index M). This division is dedicated to
the intensive observation of high-risk pregnancies. The division also admits in its P* function,
patients with a pregnancy at high risk for neonatal observation at a Neonatal Intensive Care
(NIC) service and patients who will need highly specialized postpartum care.” The P* function
is mandatory constituted by a MIC-service and a NIC (Neonatal Intensive Care) service;
the MIC-service will serve as a referral centre for a group of hospitals totalizing a
minimum of 5000 deliveries per year; a convention must be signed between each
hospital and the MIC-service”.
However, the Royal Decree has not precisely defined the statute, nor the function and
terms of reference of a MIC-service. Hence, the indications during pregnancy, delivery,
or post-partum leading to an admission in a MIC-service are not specified. As a
consequence of this opacity, the functioning of the MIC-service is unknown. Do the
MIC-services actually act as reference centres? Do they treat women with more severe
pathologies than other maternities? Do the MIC-centres improve the quality of
obstetrical care? Is the resource allocation optimal?
During the last decade, the number of high-risk pregnancies has been rising and this
trend is expected to continue mainly due to advanced maternal age and associated
chronic medical conditions, and the increase of multiple gestations 1 . Therefore it is very
important to monitor this evolution and develop appropriate strategies for referral of
high- risk or complicated pregnancies to the tertiary levels of care.
More than ten years after the publication of the Royal Decree in relation of the MIC, an
evaluation was considered essential. A proposal was submitted and accepted by KCE
whereby a consortium of universities and experts, in collaboration with the
Intermutualistisch Agentschap/Agence Intermutualiste (IMA/AIM) planned to carry out
an assessment of the current situation in Belgium about the MIC-service in obstetrical
care. The goal of this research project was to collect and analyze data allowing to advise
the (health) authorities to optimize maternal and perinatal care in Belgium. The results
of this evaluation will be crucial for further reduction of maternal and perinatal
morbidity and mortality and to ensure proper use of available resources.
The purpose of the MIC-service in Belgium described in the Royal Decree. (cf. infra) is:
(1)intensive observation of high risk pregnancies, (2)admission of patients where the baby most
probably will need intensive care after delivery (intra uterine transport, IUT) and (3)admission
of patients who need highly specialised post partum care.
1 Législation et réglementation relative aux hôpitaux – 20 août 1996 . – arrêté royal fixant les normes
auxquelles une fonction de soins périnatals régionaux (fonction P*) doit satisfaire pour être agréée (M.B.
du 01/10/1996, p.25275) Art 7
http://wallex.wallonie.be/wallexII?PAGEDYN=SIGNTEXT&CODE=168723&IDREV=1&MODE=STATIC