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

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82 Maternal Intensive Care in Belgium KCE Reports 94 Table 41: Frequency of coded pathology for intermediate care in maternities with and without MIC-services (15 first more frequent pathologies) Hospitals with MIC-services (n=) Hospitals without MIC-services (n=) Naming of pathology Frequency Percent Naming of pathology Frequency Percent 1st PPROM 577 15.3% 1st Mild or unspecified pre-eclampsia 1,052 19.0% 2nd Severe fœtal malformation 531 14.1% 2nd Women with convention diabetes 855 15.4% 3rd Mild or unspecified pre-eclampsia 420 11.1% 3rd Placenta previa , without hemorrhage 638 11.5% 4th Women with convention diabetes 4th Placenta accreta and percreta 407 10.8% without hemmorhage 515 9.3% 5th Placenta previa , without 5th Severe fœtal malformation 478 8.6% hemorrhage 360 9.5% 6th Infection of amniotic cavity 182 4.8% 6th PPROM 432 7.8% 7th Olygodramnios 173 4.6% 7th Olygodramnios 217 3.9% 8th Placenta accreta and percreta 8th Intrauterine death 214 3.9% without hemmorhage 169 4.5% 9th Intrauterine death 148 3.9% 9th Infection of amniotic cavity 142 2.6% 10th History of recurrent perinatal loss 119 3.2% 10th Polyhydramnios 130 2.3% 11th Severe psychiatric disorders 91 2.4% 11th Major puerperal infection 111 2.0% 12th Polyhydramnios 77 2.0% 12th Severe psychiatric disorders 101 1.8% 13th Homozygote/double heterozygous 13th History of recurrent perinatal loss haemoglobinopathy 63 1.7% 96 1.7% 14th Substance dependency 60 1.6% 14th Acquired heart diseases 71 1.3% 15th Major puerperal infection 50 1.3% 15th Thyreotoxicosis 60 1.1% Source: Merged IMA and MKG/RCM Data 01/10/2003 – 30/09/2004 * PPROM: Preterm premature rupture of the membranes
KCE Reports 94 Maternal Intensive Care in Belgium 83 All pathologies listed in table 41, were considered as indicators to require intermediate care. However, for pathologies such as severe foetal malformation or PPROM, there are almost twice as many women (in proportion) admitted in MIC-services as in non- MIC services. Logically, the maternities with MIC service that possess always an associated NIC service treat more pathologies related to prematurity than non MIC maternities. For other pathologies such as women with convention diabetes and placenta previa, accreta and percreta, the number of women treated in non-MIC services is reasonably higher than in MIC-services. Women that were classified in the intermediate care category by the ICD-9 codes for mild or unspecified pre-eclampsia, were surprisingly outnumbered in the non-MIC hospitals. We have to note that the ICD-9 code for this pathology encompasses a large scope of criteria. 6.3 TRANSFERS 6.3.1 Transfers during pregnancy from a non-MIC to a MIC-service Number of transfers to hospital 80 70 60 50 40 30 20 10 Figure 18 shows all transfers of women during hospitalisation compared to its proportion of intermediate care women. Indeed, 862 women were transferred to a hospital with a MIC-service and 211 women (19%) were transferred to a maternity without a MIC-service. Figure 18: Number of transfers towards a maternity compared to its proportion of intermediate care women AZ Middelheim AZ St Jan Erasme CH Notre Dame / Reine Fabiola AZ St Augustinus ZOL CHU St Pierre CH La Citadelle Edith Cavell 0 0% 5% 10% 15% Pct Intermediate care women in hospital 20% 25% 30% KUL UZ Gent VUB CHU Tivoli UCL CH St Vincent et Ste Elisabeth U.I.A CHU Brugmann + hôpital des enfants Maternities without MIC-services Maternities with MIC-services The figure shows that, except 3 maternities with a MIC-service, having less than 10 transfers a year, all other maternities with MIC-services receive more transfers than maternities without a MIC-service. Figure 19 maps the MIC-beds occupation ratio by intermediate care women and the number of transfers received per MIC-bed.
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