Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE
Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE
Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE
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<strong>KCE</strong> Reports 94 <strong>Maternal</strong> <strong>Int<strong>en</strong>sive</strong> <strong>Care</strong> in Belgium 145<br />
ANNEX 2 : THEORETICAL MODEL, NOT PREGNANCY RELATED PATHOLOGY<br />
Standard care (low-risk) Grey Zone<br />
[Recomm<strong>en</strong>ded intermediate care<br />
(GRADE 2C, weak recomm<strong>en</strong>dation)]<br />
Endocrinologic disorders<br />
• Every disorder labelled as low-risk by an<br />
<strong>en</strong>docrinologist but not specified as a disorder<br />
requiring a level of intermediate care<br />
• Nephrologic disorders ²<br />
• Every disorder labelled as low-risk by an<br />
nephrologists but not specified as a disorder<br />
requiring a level of intermediate care<br />
Cardio-vascular disorders<br />
• Normal blood pressure upper limit: 140/90 mmHg<br />
• Small left to right shunts such as arterial septal<br />
defect, v<strong>en</strong>tral septal defect and pat<strong>en</strong>t ductus<br />
arteriosus<br />
• Repaired lesions with normal cardiac function<br />
Endocrinologic disorders:<br />
• Thyroid pathology with or without positive<br />
thyroid antibodies<br />
• Diabetes pati<strong>en</strong>t (not during labour and delivery)<br />
with optimal glycemic control, in consultation<br />
with a diabetologist,<br />
• All diabetes pati<strong>en</strong>ts without insuline therapy<br />
(diet) during labour and delivery<br />
Nephrologic disorders<br />
• R<strong>en</strong>al insuffici<strong>en</strong>cy: proteinuria ≤ 3g/24h<br />
• Pyelonephritis<br />
Cardio-vascular disorders<br />
• >140/90 mmHg ooo , without systemic repercussion<br />
and a diagnosis of hypert<strong>en</strong>sion before pregnancy<br />
(e.g. African population)<br />
All disorders ppp /procedures qqq that require <strong>en</strong>docarditis<br />
prophylaxis:<br />
<strong>Maternal</strong> Intermediate <strong>Care</strong><br />
[Indisp<strong>en</strong>sable intermediate care<br />
(GRADE 1C, strong recomm<strong>en</strong>dation)]<br />
Endocrinologic disorders:<br />
• Thyreotoxicosis nnn<br />
• Severe hypothyroïdism<br />
• Diabetes pati<strong>en</strong>t (not during labour and delivery)<br />
with suboptimal glycemic control, in consultation<br />
with diabetologist<br />
• All diabetes pati<strong>en</strong>ts under insuline therapy, during<br />
labour and delivery<br />
• Every disorder labelled as high-risk by an<br />
<strong>en</strong>docrinologist but not specified as a disorder<br />
requiring a level standard care<br />
Nephrologic disorders<br />
• Kidney transplant<br />
• Every disorder labelled as high-risk (e.g. lupus<br />
nephropathy, membranous glomerulonephritis,<br />
scleroderma) by a nephrologists³ but not specified as<br />
a disorder requiring a level of standard care<br />
• proteinuria > 3g/24h<br />
• Severe nephrologic infections (except pyelonephritis)<br />
Cardio-vascular disorders rrr<br />
• >140/90 mmHg sss , with systemic repercussion and a<br />
diagnosis of hypert<strong>en</strong>sion before pregnancy<br />
• Pathology of the major and/or intracranial vessels<br />
• Uncorrected cyanotic cong<strong>en</strong>ital heart disease<br />
• Large left to right shunts<br />
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.<br />
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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