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

KCE Reports 94 Maternal Intensive Care in Belgium 31
3.3.1 Definitions (national and international)
• What are the definitions of high-risk pregnancy, MIC-beds and MIC-services?
An all-encompassing evidence-based definition of high-risk pregnancy, ‘maternal
intermediate care’ or a ‘maternal intermediate care service’ was not found. Therefore
experts propose the underneath definitions based on the Belgian Royal Decree of 1996
14, 16, 18, 34
and following publications:
Maternal Intermediate Care is a level of peripartum care between the care given on
a general ward and that on an ICU. The patient population admitted to the service does
not require invasive care but needs more care than that provided on a standard
maternity ward (see standard care). Such intermediate care involves extensive
observation and monitoring of high risk pregnancies, admission of patients where the
baby most probably will need intensive care after delivery (intra uterine transport) and
admission of patients that need highly specialised post partum care. Maternal
intermediate care is appropriate for women who are conscious and have no multi-organ
dysfunction. These women need frequent monitoring of the vital signs and/or nursing
interventions, but do not require multiple organ support, mechanical ventilation,
invasive monitoring and/or artificial life support.
Maternal Intermediate Care service is a service within an accredited maternity
ward established for women during peripartum whom can benefit from maternal
intermediate care (cf. supra).
In this environment, 24 hours care is provided by one midwife (with experience in
treating high-risk pregnancies) to two patients and supervised by gynaecologyobstetrical
specialists, with experience in treating high-risk pregnancies. A neonatal
specialist and an obstetric anaesthesiologist must be available at any time.
A MIC-patient can be defined as a woman who needs extensive levels of care,
observation and permanent medical supervision during pregnancy and/or birth and/or
postpartum (up to 42 days/6 weeks) due to severe risks and/or complications and/or
underlying diseases, in the mother and/or in the foetus.
3.3.2 Criteria for admission of women in a MIC-bed?
The literature review did not result in any specific or uniform criteria for the admission
of women into a MIC-bed. In alternative approach, an exhaustive model of pregnancyand
non-pregnancy-related maternal and foetal morbidity was compiled, which allowed
us, through repeated expert rounds, to define four distinct sets of admission criteria
(morbidity- or indication based). More details can be found in the findings-chapter under
the heading construction of the ‘theoretical model’ (also see annex).
3.3.3 Effectiveness (epidemiology & guidelines)
• What are the obstetrical pathologies and risk factors that lead to admission in
MIC-services?
This research question is addressed in section 3.3
Do evidence-based guidelines to evaluate and treat patients in MIC-services exist?
Very few evidence-based guidelines for evaluation and treatment were identified that
entailed recommendations as to which level of care is indicated for various pregnancyassociated
disorders. The guidelines that were identified were included in the
‘theoretical model’.
• Do guidelines for admission and transfers of women in MIC-service exist?
No evidence-based guidelines for admission and transfer were identified that entailed
recommendations as to which level of care is indicated for various pregnancy-associated
disorders.