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

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148 Maternal Intensive Care in Belgium KCE Reports 94 Pulmonary disorders • Normal ventilatory function : PaO2 >80 mmHg, PaCO2 between 30-35 mmHg, SaO2 > 97% vvv • Mild Asthma www [Subjects were considered to have mild asthma if they had all of the following: (1) symptoms (cough, dyspnea, or wheezing) in the prior 6 months; (2) symptoms on fewer than 8 days during 4 weeks not attributable to upper respiratory tract infections; (3) FEV1 of 80% or greater predicted; and (4) were not taking daily asthma medications. ] • Every disorder labelled as low-risk by an pneumologist but not specified as a disorder requiring a level of intermediate care Autoimmune disorders • Rheumatoid arthritis² without medical treatment • Inflammatory bowel disease, without antecedents of surgery and corticoid therapy yyy and/or immunosuppressive agents • Every disorder labelled as low-risk by an immunologist/gastroenterologist but not specified as a disorder requiring a level of intermediate care Pulmonary disorders Moderate asthma: Subjects were considered to have moderate asthma if they had any of the following: (1) symptoms on 8 or more days during 4 weeks not attributable to upper respiratory tract infections; (2) FEV1 60% to 80% predicted; or (3) requirement for at least 1 daily asthma medication other than oral corticosteroids for at least 4 weeks, ie, daily inhaled -agonist (at least 2 puffs per day), theophylline (at least 1 dose per day), inhaled ipratropium (at least 4 puffs per day), or at least 2 puffs per day of inhaled cromolyn, nedocromil, or inhaled steroids Autoimmune disorders • Rheumatoid arthritis with medical treatment standard care Pulmonary disorders • Abnormal respiratory values: PaO2 < 80 mmHg, PaCO2 40 mmHg, SaO2 < 97% • Severe asthma. Subjects were considered to have severe asthma if either (1) FEV1 was less than 60% predicted or (2) they required regular (daily or every other day) oral corticosteroids for at least 4 weeks • Pulmonary (arterial) hypertension: in rest >25 mmHg, during exercise > 30 mmHg( xxx ) • Pulmonary transplant • Severe pulmonary infections (incl. complicated pneumonia) • Every disorder labelled as high-risk by a pneumologist but not specified as a disorder requiring a level of standard care Autoimmune disorders • Anti phospholipid syndrome • Systemic lupus erythematosus (with clinical symptoms) • Inflammatory bowel disease zzz (Crohn / colitis ulcerosa) aaaa with history of surgery, corticoid therapy and/or immunosuppressive agents • Every disorder labelled as high-risk by a immunologist/gastroenterologist but not specified as a disorder requiring a level of standard care vvv Personal communication with dr. Brouckaert (pneumologist UZGent, August 06, 2007) www Schatz et al. (2003). Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immuno, 112, 283-288. [National Asthma Education Program Report of the Working Group on asthma and pregnancy. Management of asthma during pregnancy. Bethesda (MD): National Heart, Lung, and blood institute; 199393-3279A.] xxx Budev, M, Arroliga, A. & Emery, S. (2005). Exacerbation of underlying disease in pregnancy. Critical care medicine, 33, s313-318. yyy Personal communication with prof Dr. Devos (gastro-enterologist UZGent, July, 28 th 2007) zzz Carter, M., Jobo, A. & Travis, S. (2004). Guidelines for the management of inflammatory bowel disease in adults. Retrieved on June, 20, 2007 from the British society of Gastroenterology: http://www.bsg.org.uk/pdf_word_docs/ibd.pdf aaaa Vienna Classification” and recent “Montreal modification” (2005.) Retrieved June 12, 2007, from Cebam, tripdatabase: http://www.merck.com/mmpe/sec02/ch018/ch018b.html). Inflammatory bowel disease aaaa (Crohn / colitis ulcerosa). Crohn’s disease into three principal patterns: (1) primarily inflammatory, which after several years commonly evolves into either (2) primarily stenotic or obstructing or (3) primarily penetrating or fistulizing.
KCE Reports 94 Maternal Intensive Care in Belgium 149 Connective tissues disorders • Every disorder labelled as low-risk by an connective tissue specialist but not specified as a disorder requiring a level of intermediate care Skeletal disorders • Osteogenesis imperfecta ffff type I • Every disorder labelled as low-risk by an orthopaedist but not specified as a disorder requiring a level of intermediate care Neuromuscular disorders • Every disorder labelled as low-risk by an neurologist but not specified as a disorder requiring a level of intermediate care Connective tissues disorders Skeletal disorders Neuromuscular disorders • Well equilibrated epileptic patient (or no active medical treatment) Connective tissues disorders • Marfan’s disease (Gent nosology bbbbccccdddd ) • Ehlers-Danlos’ disease (type I – XI eeee ) • Every disorder labelled as high-risk by a connective tissue specialist but not specified as a disorder requiring a level of standard care Skeletal disorders • Osteogenesis imperfecta: type II-VII • Every disorder labelled as high-risk by a orthopaedist but not specified as a disorder requiring a level of standard care Neuromuscular disorders • Epileptic patient gggg (with active medical treatment) • Myasthenia gravis (class I – IVb) • Steinert’s disease • Amyotrophic lateral sclerosis • Hemi-/para-/tetraplegy • Spina bifida • Multiple sclerosis hhhh • Severe neuromuscular infections • Every disorder labelled as high-risk by a neurologist but not specified as a disorder requiring a level of standard care bbbb Dean, J. et al (2003). The Scottish clinical guidelines and integrated care pathways for Marfan’s syndrome. Retrieved June 1, 2007 from cebam, National guideline clearinghouse http://www.genisys.hw.ac.uk/genisysDR/NVC/72/Download/msguide.pdf cccc De Paepe A, Devereux RB, Dietz HC, Hennekam RC, Pyeritz RE (1996). Revised diagnostic criteria for the Marfan Syndrome. Am J Med Genet; 62: 417-426. dddd Beighton, P., De Paepe, A., Steinmann, B., Tsipouras, P. & Wenstrup, R. (1998). Ehler-Danlos Syndromes: revised nosology, Villefranche, 1997. American Journal of Medical genetics, 77, 31-37. eeee Ceccolini, E. (2006). Ehler-Danlos syndrome. Retrieved June 5, 2007 from cebam, emedecine : http://www.emedicine.com/derm/topic696.htm. ffff Rauch, F. & Glorieux, F.H. (2004). Osteogenesis Imperfecta. Lancet. 363(9418):1377-85. I Mild non-deforming: Normal height or mild short stature; blue sclera; no dentinogenesis imperfecta.; II Perinatal lethal: Multiple rib and long-bone fractures at birth; pronounced deformities; broad long bones; low density of skull bones on radiographs; dark sclera; III Severely deforming: Very short; triangular face; severe scoliosis; greyish sclera; IV Moderately deforming: Moderately short; mild to moderate scoliosis; greyish or white sclera; dentinogenesis imperfecta; V Moderately deforming: Mild to moderate short stature; dislocation of radial head; mineralised interosseous membrane; hyperplastic callus; white sclera; no dentinogenesis imperfecta; VI Moderately to severely: Moderately short; scoliosis; accumulation of osteoid in bone tissue, fish-scale pattern of deforming bone lamellation; white sclera; no dentinogenesis imperfecta; VII Moderately deforming: Mild short stature; short humeri and femora; coxa vara; white sclera; no dentinogenesis imperfecta gggg National collaborating centre for women’s and children’s health. Antenatal care routine care for the healthy pregnant woman, Clinical guideline 23. Retrieved June 18, 2007 from cebam, rcog: http://www.rcog.org.uk/resources/Public/pdf/Antenatal_Care.pdf.
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