Publications by authors named "Anne Alice Chantry"

4 Publications

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Repeated maternal ICU admission: results from a nationwide analysis.

Anaesth Crit Care Pain Med 2021 Jun 18:100905. Epub 2021 Jun 18.

Université de Paris, Center of Research in Epidemiology and Statistics/CRESS/Obstetrical Pediatric and Perinatal Epidemiology Research Team (EPOPé), INSERM, INRA, 53 avenue de l'observatoire, 75014 Paris, France.

Objective: To determine the rate and profile of repeated maternal ICU admissions during or after pregnancy and to compare the characteristics of these women's first and second ICU admissions.

Methods: A descriptive analysis from the French national hospital discharge database that included all women admitted to an ICU during pregnancy or within 42 days after delivery, between 2010 and 2014.

Results: During the 5-year study period, there were 371 women with more than one maternal ICU admission, representing 2.5% of all women admitted during or after pregnancy (371/15,096) and a 0.9 per 10,000 deliveries (371/4,030,409) rate of repeated maternal ICU admission. Compared with women with only one maternal ICU admission, those with repeated maternal ICU admissions were more often admitted during the pregnancy rather than during or after the delivery stay (P < 0.001), for organ failure or sepsis (P < 0.001), and with a SAPS-II score >25 (P < 0.001). Women with repeated admissions were usually readmitted for the same indications and had similar SAPS-II scores. Half of ICU readmissions occurred within 72 hours of first ICU discharge, with similar causes and levels of severity for both stays.

Conclusion: Although the rate of women with repeated maternal ICU admissions was low, their initial stay had a specific profile of causes of admission and greater severity compared with the stay of women admitted only once. The pattern and similar characteristics of both first and second ICU admission and the short interval for readmission suggests that some ICU discharges may have been potentially premature.
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http://dx.doi.org/10.1016/j.accpm.2021.100905DOI Listing
June 2021

Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study.

Anesth Analg 2021 May 14. Epub 2021 May 14.

From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.

Background: Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion.

Methods: We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012-2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts' consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models.

Results: Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria.

Conclusions: Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.
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http://dx.doi.org/10.1213/ANE.0000000000005578DOI Listing
May 2021

Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes.

PLoS One 2019 12;14(2):e0211955. Epub 2019 Feb 12.

Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.

Objectives: Most indicators proposed for assessing quality of care in obstetrics are process indicators and do not directly measure health effects, and cannot always be identified from routinely available databases. Our objective was to propose a set of indicators to assess the quality of hospital obstetric care from maternal morbidity outcomes identifiable in permanent hospital discharge databases.

Methods: Various maternal morbidity outcomes potentially reflecting quality of obstetric care were first selected from a systematic literature review. Then a three-round Delphi consensus survey was conducted online from 11/2016 through 02/2017 among a French panel of 37 expert obstetricians, anesthetists-critical-care specialists, midwives, quality-of-care researchers, and user representatives. For a given maternal outcome, several definitions could be proposed and the indicator (i.e. corresponding rate) could be applied to all women or restricted to specific subgroup(s).

Results: Of the 49 experts invited to participate, 37 agreed. The response rate was 92% in the second round and 97% in the third. Finally, a set of 13 indicators was selected to assess the quality of hospital obstetric care: rates of uterine rupture, postpartum hemorrhage, transfusion incident, severe perineal lacerations, episiotomy, cesarean, cesarean under general anesthesia, post-cesarean site infection, anesthesia-related complications, postpartum pulmonary embolism, maternal readmission and maternal mortality. Six were considered in specific subgroups, with, for example, the postpartum hemorrhage rate assessed among all women and also among women at low risk of PPH.

Implications: This Delphi process enabled us to define consensually a set of indicators to assess the quality of hospital obstetrics care from routine hospital data, based on maternal morbidity outcomes. Considering 6 of them in specific subgroups of women is especially interesting. These indicators, identifiable through codes used in international classifications, will be useful to monitor quality of care over time and across settings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211955PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372226PMC
November 2019

Pregnancy-related ICU admissions in France: trends in rate and severity, 2006-2009.

Crit Care Med 2015 Jan;43(1):78-86

1Institut National de la Santé et de la Recherche Médicale 1153, Obstetrical, Perinatal and Pediatric Epidemiology Resear team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France. 2Baudelocque Midwifery School, Assistance Publique des Hôpitaux de Paris, Paris, France. 3Departments of Anaesthesia and Critical Care, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.

Objective: To determine the national rate per delivery of pregnancy-related ICU admissions of women in France, the characteristics and severity of these cases, and their trends over the 4-year study period.

Design: Descriptive study from the national hospital discharge database.

Setting: All ICUs in France.

Patients: All women admitted to an ICU during the pregnancy, the delivery, or the postpartum period from January 1, 2006, to December 31, 2009.

Interventions: None.

Measurements And Main Results: Of 3,262,526 deliveries, 11,824 women had pregnancy-related ICU admissions, for an overall rate of 3.6 per 1,000 deliveries. The conditions reported most frequently were obstetric hemorrhages (34.2%) and hypertensive disorders of pregnancy (22.3%). Case severity was assessed with four markers: case-fatality rate (1.3%), length of ICU stay (mean, 3.0 ± 0.1 d), Simplified Acute Physiology Score II score (mean: 19.7 ± 0.1), and a SUP REA code, which indicates the combination of a Simplified Acute Physiology Score II score more than or equal to 15 and at least one specific procedure related to life support or organ failure (23.0%). The most frequent causes of ICU admission were those associated with the least severity in the ICU. During the study period, the rate of pregnancy-related ICU admissions decreased from 3.9 to 3.4 per 1,000 deliveries (p < 0.001), whereas the overall severity of cases increased with longer stays, higher Simplified Acute Physiology Score II scores, and a greater proportion of SUP REA codes (all p < 0.001). Analysis by principal diagnosis showed that the severity of the condition of women admitted to ICU significantly increased over time for hemorrhages and hypertensive complications.

Conclusions: The rate of women with pregnancy-related ICU admissions decreased and the severity of their cases increased. Most ICU admissions remained related to the least severe conditions. This raises the issue of the most appropriate organization of care for women with pregnancy-related conditions who require continuous surveillance but not necessarily intensive care.
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http://dx.doi.org/10.1097/CCM.0000000000000601DOI Listing
January 2015