Guidelines for the management of urgent obstetric situations in emergency medicine, 2022 - 10/09/22
, Loïc Sentilhes b, Frédéric J. Mercier c, Paul Berveiller d, Julie Blanc e, Eric Cesareo f, Pierre-Yves Dewandre g, Bénédicte Douai h, Aurélie Gloaguen i, Max Gonzalez j, Philippe Le Conte k, Agnès Le Gouez c, Hugo Madar b, Emeline Maisonneuve l, Estelle Morau m, Thibaut Rackelboom n, Mathias Rossignol o, Jeanne Sibiude p, Julien Vaux q, Alexandre Vivanti r, Sybille Goddet s, Patrick Rozenberg d, Marc Garnier t, Anthony Chauvin u, vAbstract |
Objective |
To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward.
Design |
A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded.
Methods |
Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method.
Results |
Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made.
Conclusions |
There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine.
Le texte complet de cet article est disponible en PDF.Keywords : Emergency, Obstetrics, Postpartum
Plan
| ☆ | Validated by the SFAR Clinical Guidelines Committee on the 28th of February 2022, the SFAR Board of Directors on the 04th of March 2022, the SFMU Guidelines Committee) on the 26th of January 2022, the SFMU Board of Directors on the 31st of March 2022 and the CNGOF Scientific Council on 01st of April 2022. |
| ☆☆ | Recommendations for Professional Practice issued by the French Society of Emergency Medicine (Société française de médecine d’urgence - SFMU), the French Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie et de réanimation - SFAR), and the French National College of Gynaecologists and Obstetricians (Collège national des gynécologues et obstétriciens français - CNGOF). |
Vol 41 - N° 5
Article 101127- octobre 2022 Retour au numéro
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