Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE
Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE
Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE
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62 <strong>Maternal</strong> <strong>Int<strong>en</strong>sive</strong> <strong>Care</strong> in Belgium <strong>KCE</strong> Reports 94<br />
Indirect obstetrical complications: Cardiac and vascular disease (e.g. hypert<strong>en</strong>sion,<br />
thyrotoxicosis, plasmapheresis, anaemia, …), pulmonary disease (e.g. asthma or<br />
pneumonia, …), neurological disease , gastro-intestinal disease (e.g. diabetes mellitus,<br />
cholecystitis, pancreatitis, app<strong>en</strong>dicitis, peritonitis, …), <strong>en</strong>docrine disease<br />
(e.g. thyrotoxicosis, …), infectious and parasitical disease, drug dep<strong>en</strong>d<strong>en</strong>ce,<br />
intoxication, trauma, psychiatric disease, …<br />
As m<strong>en</strong>tioned above a widely used cons<strong>en</strong>sus list of indications for admission on a MICservice<br />
doesn’t exist, every country/hospital has its own way of referring and admitting<br />
high risk obstetrical pati<strong>en</strong>ts. Therefore we try to develop a “Belgian” list.<br />
5.2 METHODOLOGY<br />
The process of retrieving the indications (see annex) for admission to (in-hospital)<br />
obstetric intermediate care followed differ<strong>en</strong>t systematically ordered steps, as explained<br />
below.<br />
First, the P.I.C.O. (Pati<strong>en</strong>t, Interv<strong>en</strong>tion, Comparison, Outcome) model for clinical<br />
questions was used to id<strong>en</strong>tify all relevant information and keywords about admission<br />
criteria for the maternal intermediate care unit and to get a clear view on the problem<br />
wherefore information was to be found. In this phase we mainly focused on (clinical)<br />
guidelines, due to the lack of evid<strong>en</strong>ce on the topic.<br />
The databases were accessed through CEBAM (a portal site that gathers up to date<br />
evid<strong>en</strong>ce based search <strong>en</strong>gines, CEBAM digital library is the Belgian branch of the<br />
Cochrane collabouration). The following search <strong>en</strong>gines were systematically used for<br />
evid<strong>en</strong>ce based guidelines on standards for maternal intermediate or int<strong>en</strong>sive care (as<br />
defined in deliverable 1).<br />
In the Dutch-language databases (CBO, Nederlands Huisarts<strong>en</strong>g<strong>en</strong>ootschap, Richtlijn<strong>en</strong><br />
K<strong>en</strong>nisc<strong>en</strong>trum (<strong>KCE</strong>), RIZIV richtlijn<strong>en</strong> and WVVH Domus Medica), all topics related<br />
to peripartal care were investigated for guidelines on intermediate obstetric care. Three<br />
guidelines concerning pr<strong>en</strong>atal and postpartum care were id<strong>en</strong>tified. These guidelines<br />
provide standards for low-risk pregnancies, but very limited information about<br />
intermediate care for complicated or problematic pregnancies within a hospital setting.<br />
In other words no Dutch guideline fitted to the goal of the query. Furthermore, Anglo-<br />
Saxon guidelines search <strong>en</strong>gines (Guideline Finder UK, National Guideline<br />
Clearinghouse, New Zealand Guidelines Group, Prodigy Guidelines and WHO) were<br />
used with keywords: obstetric (intermediate) care, peripartal care, pregnancy care and<br />
high risk, maternity services (and high risk), maternity care, disease and pregnancy, high<br />
dep<strong>en</strong>d<strong>en</strong>cy unit. These keywords were also combined with each other wh<strong>en</strong> the<br />
number of guidelines found was too large. Within the pot<strong>en</strong>tial relevant guidelines we<br />
searched for everything related to high-risk, complication and problem. Time<br />
restrictions were set on 1995 to 2007.<br />
5.2.1 Guidelines<br />
This ext<strong>en</strong>sive search resulted in two types of guidelines, g<strong>en</strong>eral (low risk) maternity<br />
care guidelines and guidelines on a specific topic of complicated peripartal care e.g.<br />
diabetes & pregnancy, cardio-vascular problems, … . This same t<strong>en</strong>d<strong>en</strong>cy was se<strong>en</strong> in<br />
the g<strong>en</strong>eral literature search. We found no specific guidelines concerning overall<br />
intermediate obstetrical care, we did found some g<strong>en</strong>eral guidelines concerning<br />
admission and discharge from g<strong>en</strong>eral int<strong>en</strong>sive care and high dep<strong>en</strong>d<strong>en</strong>cy/intermediate<br />
care units. Within these g<strong>en</strong>eral admission and discharge criteria nothing was specifically<br />
m<strong>en</strong>tioned for pregnancy and childbirth.<br />
Due to the poor results of the searches in the above m<strong>en</strong>tioned guideline databases, the<br />
EBM search <strong>en</strong>gines Tripdatabase and Sumsearch were subsequ<strong>en</strong>tly searched and gave<br />
access to respectively evid<strong>en</strong>ce based synopses, clinical questions, systematic reviews,<br />
guidelines (North America, Europe and other), core primary research and e-textbooks<br />
related to a specific topic (see keywords). One relevant guideline was id<strong>en</strong>tified: Finnish<br />
Medical Society Duodecim (2006). Systemic diseases in pregnancy. Retrieved May 15,<br />
2007 from Cebam, National guideline clearinghouse : www.guideline.gov.