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

KCE Reports 94 Maternal Intensive Care in Belgium 29
In an answer to this paper, the French group from the Centre region presented similar
data and prevalence: among 15,281 deliveries in 14 maternity services, there was one
maternal death, due to thromboembolism. Fifty events involved severe maternal
morbidity, a rate of 3.3 per thousand 28 .
E. ICU studies
There are a large amount of these studies, often not population based. A systematic
review has been made in 2006 by 5 , reporting on 29 such studies. The interesting
conclusions are that more than 50% of all such admissions are related either to preeclampsia
or to haemorrhage. The other interesting information is that the median
length of stay is short, ranging from 1 to 6 days.
Another important ICU study originates from the SW Thames area 16 , reports on 122
850 deliveries, leading to 210 ICU admissions. The interesting aspect is that the
prevalence is about 10 times lower than other studies, presumably reflecting the fact
that less severe cases were admitted to HDU rather than ICU. The other interesting
aspect is that the APACHE score was systematically tested, and found inappropriate for
obstetrical patients.
F. Other conditions
A limited number of potentially life-threatening conditions will be addressed separately.
This will be the case for trauma and domestic violence. These are being addressed
separately either because of their burden, or because they are apt to not be addressed
with the filters which have been used for identification of severe conditions.
TRAUMA
Trauma registry data reveal that the incidence of pregnancy complicating trauma ranges
from 4.6% to 8.3%; conversely, trauma complicated one in 12 pregnancies 29, 30 29 .
Trauma is one of the leading causes of death in women of child-bearing age. The
previous studies showed that the aetiology of maternal trauma is most often motor
vehicle accidents (55%), followed by falls (22%), assaults (22%), and burns (1%) 31 . Foetal
deaths have a different aetiology: motor vehicle accidents (82%), gun shot wounds (6%),
and falls (3%), with maternal death accounting for 11% of the foetal deaths 32 .
DOMESTIC VIOLENCE
A comprehensive literature search was carried out by Boy and Salihu 33 , including 30
peer reviewed publications. They conclusions are as follows. Overall, adverse
pregnancy outcomes, including low birth weight, maternal mortality and infant mortality
are significantly more likely among abused than non-abused mothers.
The risk for maternal mortality is three times as high for abused mothers. Intimate
partner violence is also responsible for increased foetal deaths in affected pregnancies
(about 16.0 per 1000).
3.2.4 Conclusion
A somewhat crude approach is to consider the following. A near miss is a case where
without care (in most cases advanced life support technology) it can be hypothesised
that the patient would have died.
A severe condition is one which potentially might have become a near miss, but did not
present the severe organ failure which qualifies near miss. A medical condition
concerns all pregnant women who presented with a “disease” concomitant to
pregnancy, regardless of whether this disease was pregnancy related or not, and of
whether the patient was admitted to hospital or not.
It is simplistic, but easy to remember that, in the more affluent OCDE countries, orders
of magnitudes are as follow for 100.000 deliveries.