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

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144 Maternal Intensive Care in Belgium KCE Reports 94 - hemorragie >1000ml, al dan niet na placentaire retentie - sfincterruptuur graad IV - infecties waarvoor parenterale AB-toediening is vereist - gecompliceerde SC/kunstverlossing - elke kraamvrouw met opname van de baby op NICU, onafhankelijk van de plaats van bevalling 3. Bij verstrijken van bovengenoemde termijn of wanneer er geen bedreiging meer is voor materneel/foetaal welzijn, wordt patiente terugverwezen naar de verwijzende gynaecoloog. 2. ANDERE PATHOLOGIEËN Pathologie die besproken wordt op de multidisciplinaire staffvergadering obstetrie – neonatologie. Het staat de verwijzer vrij een patiente door te verwijzen naar een MIC-arts, ook indien de pathologie niet strikt is opgenomen in de lijst. Ook kan elke gynaecoloog/verwijzer een delicaat dossier voorstellen op de staff vergadering om zo advies in te winnen omtrent zwangerschap en/of bevalling. Iedere klinische opname van een dergelijke patiente is een MIC-opname. 01/05/2007 Dr . K. Roelens – Dr. E. Roets – Prof. Dr. M. Temmerman (Bronnen :KB 01/10/1996 - sturingsgroep Verloskunde UZ Leuven – AZ St Augustinus)
KCE Reports 94 Maternal Intensive Care in Belgium 145 ANNEX 2 : THEORETICAL MODEL, NOT PREGNANCY RELATED PATHOLOGY Standard care (low-risk) Grey Zone [Recommended intermediate care (GRADE 2C, weak recommendation)] Endocrinologic disorders • Every disorder labelled as low-risk by an endocrinologist but not specified as a disorder requiring a level of intermediate care • Nephrologic disorders ² • Every disorder labelled as low-risk by an nephrologists but not specified as a disorder requiring a level of intermediate care Cardio-vascular disorders • Normal blood pressure upper limit: 140/90 mmHg • Small left to right shunts such as arterial septal defect, ventral septal defect and patent ductus arteriosus • Repaired lesions with normal cardiac function Endocrinologic disorders: • Thyroid pathology with or without positive thyroid antibodies • Diabetes patient (not during labour and delivery) with optimal glycemic control, in consultation with a diabetologist, • All diabetes patients without insuline therapy (diet) during labour and delivery Nephrologic disorders • Renal insufficiency: proteinuria ≤ 3g/24h • Pyelonephritis Cardio-vascular disorders • >140/90 mmHg ooo , without systemic repercussion and a diagnosis of hypertension before pregnancy (e.g. African population) All disorders ppp /procedures qqq that require endocarditis prophylaxis: Maternal Intermediate Care [Indispensable intermediate care (GRADE 1C, strong recommendation)] Endocrinologic disorders: • Thyreotoxicosis nnn • Severe hypothyroïdism • Diabetes patient (not during labour and delivery) with suboptimal glycemic control, in consultation with diabetologist • All diabetes patients under insuline therapy, during labour and delivery • Every disorder labelled as high-risk by an endocrinologist but not specified as a disorder requiring a level standard care Nephrologic disorders • Kidney transplant • Every disorder labelled as high-risk (e.g. lupus nephropathy, membranous glomerulonephritis, scleroderma) by a nephrologists³ but not specified as a disorder requiring a level of standard care • proteinuria > 3g/24h • Severe nephrologic infections (except pyelonephritis) Cardio-vascular disorders rrr • >140/90 mmHg sss , with systemic repercussion and a diagnosis of hypertension before pregnancy • Pathology of the major and/or intracranial vessels • Uncorrected cyanotic congenital heart disease • Large left to right shunts nnn Lyndal, R. et al. (2005). Outcomes of pregnancy complicated by thyroid disease. The Australian and New Zealand Journal of Obstetrics and Gynaecology 45 , 239–242. ooo Finnish Medical Society Duodecim (2006). Systemic diseases in pregnancy. Retrieved Mai 15, 2007 from Cebam, National guideline clearinghouse : www.guideline.gov.
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Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

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