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

KCE Reports 94 Maternal Intensive Care in Belgium 15
3.1.2 Critical appraisal
The critical appraisal of the selected articles (after full text evaluation) was based on the
checklist for observational studies from the AHRQ (Agency for Healthcare Research
and Quality). To evaluate the quality of the small number of selected guidelines (due to
the lack of relevant guidelines) we used the AGREE-instrument. Two individual
researchers 4 performed separately the assessment of the selected studies, the result of
the final selection is presented in an evidence table (see annexes) with a summary of the
selected articles.
The hierarchy of articles goes down from: Cochrane review, systematic review, review
(based on the levels of evidence), randomized controlled trial, controlled clinical trial.
Most of the articles are level 3 articles (no-experimental descriptive research with a
good design: comparative research, correlation research and case-studies) or level 4
(report of expert groups, expert opinions, clinical experience of respected authorities).
After detailed evaluation, full text evaluation and critical appraisal, 12 articles were
selected from Medline, 2 from Embase and not any from Cochrane library. The search
in the CINHAL database did not result in any potential relevant article.
3.1.3 Methodology construction of definitions
Due to the lack of literature, unambiguous definitions and evidence, we needed an
alternative approach to obtain a definition that could serve as a basis for our research.
The definitions were constructed by the means of the Delphi-method. A written
proposition was made and sent to all the partners of the research group. They
commented on the preliminary version and all of these comments were gathered and
discussed in a meeting. After the meeting a reworked written proposal was made and
the whole procedure was repeated. To obtain consensus, we had 4 rounds and
consequently the definitions were mainly expert-based.
In the underneath results-section we present the most important findings from our
literature search.
3.1.4 Results
We like to point out that the concept Maternal Intensive Care is in Belgium understood
as a level of intermediate care. The MIC-services in Belgium are not Intensive Care
Units (cf. definition), specialized in peripartum complications. MIC-services provide a
level of care between standard and intensive care (cf. infra). 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.
This confusion of meanings and different interpretations is also found in the
international literature. Every country has its own system of health care and
terminology to refer to what we understand in Belgium as MIC. Moreover these
country-specific terminology and concepts are scarcely explained in the found studies.
This is probably due to the obviousness of these different health care contexts to the
authors.
The concept ‘maternal intermediate/intensive care’ was not found elsewhere. We did
found concepts referring in a certain sense to what ranges under MIC namely: highdependency
care, maternity high-dependency care, obstetrical intermediate care,
emergency obstetric care, and obstetric critical care, intensive care in obstetrics,
maternity recovery ward, obstetric services, and operative obstetric services.
Terms that refer to the MIC-service are: intensive care unit, intensive therapy unit, high
dependency unit, maternal high dependency unit, post anaesthesia care unit, critical care
obstetric unit, maternity recovery ward, obstetrical intermediate care unit, high-risk
antepartum unit, maternal-foetal ICU’s, consultant obstetric units, recovery area for
obstetric patients, obstetrical ICU’s, obstetric hospital 1, 5-8 .
4 dr. Hans Verstraelen and Ms. Van Parys.