[Intensive care of pregnant and puerperal women. Characteristics of patients and health management structures].
BACKGROUND
In order to understand why maternal mortality is higher in France than in other comparable countries, an epidemiological survey was carried out concerning critical illness during pregnancy, delivery and post partum, to ascertain the frequency of critical illnesses, and describe the characteristics of the patients as well as of the obstetrical services caring for them.


METHODS
The survey was carried out on all obstetric patients treated in intensive care units (ICU), in three French regions for one year. A detailed questionnaire was retrospectively filled out by a specialized investigator, according to the patient's medical file.


RESULTS
The frequency of critical illness was estimated at 310 SD 36 per 100,000 live births. Hypertensive diseases (26%) are the most frequent diagnosis that motivated admission to ICU, followed by the hemorrhages (20%), and then the indirect obstetric causes (17%). A large part of these patients was affected by seriously poor conditions before the present pregnancy. Public hospitals were most often implicated in the care of these patients since the beginning of the pregnancy and still more at the moment of the delivery. There was no difference in prenatal care from one type of hospital to another. On the contrary, pathologies and hospitalisation during pregnancy then the causes and the time of admission to ICU as well as the seriousness of maternal conditions were statistically different from one type of hospital to much more frequently in such pregnancies. Letality did not differ according to the various classes of maternity ward but did differ according to the pathologies leading to the treatment in ICU.


CONCLUSIONS
A large proportion of pregnant women experience seriously critical illness; the relationship between critical illness and maternal mortality according to health care must be studied in depth.
Bouvier-Colle
M H
MH
INSERM U149, Recherches Epidémiologiques sur la Santè des Femmes et des Enfants, Paris.
Ancel
P Y
PY
Varnoux
N
N
Salanave
B
B
Fernandez
H
H
Papiernik
E
E
Bréart
G
G
D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness; D005260:Female; D005602:France / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000628:therapy*; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
Soins intensifs des femmes en état gravido-puerpéral. Caractéristiques des patientes et structures de prise en charge.