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

KCE Reports 94 Maternal Intensive Care in Belgium 23
3.2.3 Results
A. Main causes of maternal death
These can be divided into obstetrical and non obstetrical (cf. supra). Only the 1 st
category will be considered, as the other conditions are less likely to be admitted to
intensive care or high dependency units.
The following are the leading causes and prevalence (per million) of maternal death over
the last published nine years.
• Direct causes
o Thrombosis and thromboembolism 16.0
o Hypertensive disease of pregnancy 7.5
o Haemorrhage 7.5
o Amniotic fluid embolism 3.8
o Early Pregnancy 7.2
o Sepsis 6.6
o Uterine trauma 3.7
o Anaesthesia 2.6
• Indirect causes
o Cardiac indirect 15.0
o Psychiatric indirect 20.0
o Cancer indirect 4.2
o Other indirect 36.0
In effect many of these conditions are very dramatic, and it would be unusual for the
patient to be admitted for a long duration stay prior to the development of the
condition in most cases. The most notable exceptions to this assumption are probably
the indirect cardiac and psychiatric deaths, but it can be hypothesised that such cases
would mostly not be admitted to a MIC.
We consequently conclude that the examination of maternal deaths gives good
information about the causes of deaths, but does not contribute much to decisions
regarding the needs for maternal intensive and high dependency care.
We therefore proceeded to analyse published reports of maternal morbidity,
attempting to restrict the review to severe morbidity. This was done in three steps:1)
analysis of the wording in use to distinguish severe from non severe morbidity and
conceptualisation of indicators; 2) review of published data in relation to hospitalisation
or to population based reporting, and 3) finally, for certain conditions specific papers on
the topic have been included.
B. Conceptualisation of severe morbidity and wording in use
This section is largely inspired by the work which has been done within the PERISTAT
European Union group working group on maternal morbidity. Much of the primary
work related to disease, management or organ classification was due to Geller and
associates, 3 2 and is in effect an extension to maternal and child health of concepts
already used in adult intensive care. Four concepts will be addressed: disease based
definitions, management based definitions, organ failure based definitions and combined
approach definitions.
C. Disease-based definitions of maternal morbidity
A common approach among studies is to use definitions based on disease-specific
morbidities.
Examples of these can be found in the MOMS-B EU study, which used common
definitions for given conditions (severe preeclampsia, sepsis and haemorrhage which
were then prospectively collected during a 12 month in 11 regions of Europe 19 .