Prévalence et facteurs prédictifs du syndrome d’apnée obstructive du sommeil au décours de l’infarctus du myocarde

Background

Obstructive sleep apnea has been implicated in the pathogenesis and aggravation of coronary atherosclerosis. However, it remains underdiagnosed in cardiology practice.

Aim

The aim of this study was to determine the prevalence of obstructive sleep apnea and the predictors of severe sleep apnea in patients admitted for ST elevation myocardial infarction.

Methods

This was a prospective study which has included 120 patients hospitalized for ST elevation myocardial infarction, from April 2011 to March 2012. All patients have undergone an overnight sleep study using a portable polygraphy device, in the 15 days following the acute coronary syndrome. The diagnostic of obstructive sleep apnea was considered as apnea–hypopnea index of ≥ 5 events per hour, severe sleep apnea was defined as apnea –hypopnea index of ≥ 30. Subjective daytime sleepiness was assessed by the Epworth sleepiness scale. All patients have had an oxygen saturation monitoring in the coronary care unit using a pulse oxymeter, before undergoing the sleep study.

Results

The study population was made up of 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor found in 72% of all patients, diabetes and hypertension were represented in 40% and 44% of the population, respectively. Eighty-seven percent of patients were admitted in the first 24 hours of symptom onset. A primary percutaneous coronary intervention was performed in 60% of cases while fibrinolysis was done in 10% of patients. The prevalence of obstructive sleep apnea was 79%. Mean apnea–hypopnea index was 15.76 ± 14.93 and severe form was diagnosed in 16% of all patients. Multivariate analysis showed that Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe obstructive sleep apnea.

Conclusion

Prevalence of obstructive sleep apnea was very high in patients admitted for acute myocardial infarction. Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe form of sleep apnea.     

Fibrose rétropéritonéale idiopathique : évolution à long terme du pronostic rénal dans une série rétrospective multicentrique de 30 cas

Purpose

Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory disorder, affecting the aorta and the surrounding vessels and tissues. The prognosis is mainly driven by the risks of chronic kidney disease and relapse. Our aim was to assess the prevalence of chronic kidney disease at follow-up.

Methods

We retrospectively reviewed the medical records of patients diagnosed for IRF in Seine-Saint-Denis (France) between 1987 and 2011. We collected informations about presentation, radiologic findings and follow-up. Diagnosis of IRF was confirmed when all the following criteria were met: infiltration of the infrarenal aorta or iliac vessels, absence of aneurysmal dilation, lack of clinical suspicion of malignancy.

Results

Thirty patients were identified, with a male/female ratio of 4.9. Mean age was 55 ± 13 years old. The mean creatinine clearance was 66 mL/min/1.73 m² and the mean CRP was 45 ± 36 mg/L. In 24 (80%) patients, the location of IRF was periaortic and periiliac. Eleven patients (37%) underwent a diagnostic biopsy, and 14 (47%) required an ureteral procedure. A mean follow-up of 63 months was available for 29 patients: 69% relapsed, 7 developed chronic renal disease (24%), and one died of urinary sepsis. Older age (P = 0.023), diabetes (P = 0.007), and initial renal insufficiency (P = 0.05) were associated with a risk of chronic renal insufficiency.

Conclusion

The high frequency of relapses and chronic renal disease emphasizes the need of close follow-up in patients diagnosed with IRF.     

Fibrose(s) rétropéritonéale(s) : stratégie diagnostique,pathologies associées et suivi à long terme d’une cohorte française

Purpose

Retroperitoneal fibrosis (RPF) is a rare disease with an expanding etiologic spectrum. We aimed to analyze non-invasive diagnosis strategy, associated disorders, monitoring, treatment and prognosis.

Methods

Retrospective cohort study in a single tertiary center.

Results

Eighteen RPF cases (11 males) followed between 1996 and 2009 were reviewed. Blood CRP level was high in all cases before treatment. CT scan, associated or not with MRI or 18-FDG PET-scan, confirmed the diagnosis in 15 patients. Histological analysis of a surgical biopsy specimen was performed in only three cases. Ten patients suffered retroperitoneal fibrosis secondary to systemic vasculitis (granulomatosis with polyangeitis, n = 1, Takayasu aortitis, n = 2), systemic fibrosis with Riedel thyroiditis (n = 1) and atheromatous periaortitis (n = 6). Fifteen patients were treated with corticosteroids with a mean treatment duration of 60 months (12–228). Dependency to corticosteroids was recorded in ten patients. Patients with fibrosis related to vasculitis were younger, had a higher CRP level, more frequent corticosteroid dependency and a higher relapse rate. Relapses were successfully treated with steroids. Immunosuppressive treatment was only prescribed in the setting of systemic vasculitis. No patient died, after a 6 ± 2 years follow-up. Late relapses could occur, sometimes years after steroid therapy cessation.

Conclusion

In our study, RPF occurred as a secondary disorder in 60% of the cases. Disease extension, relapse rate and treatment response varied according to the underlying cause of RPF, pleading for an extensive and systematic initial assessment. Since no death or end-stage renal insufficiency was observed, RPF might be considered as a steroid-sensitive and benign disorder.     

Hypertension artérielle et obésité : disparités entre quatre régions d’Outre-mer

Background and purpose

The epidemiological characteristics of hypertension and obesity in French overseas territories (FOTs) have never been compared.

Methods

This cross-sectional survey included representative population-based samples of 602, 601, 620 and 605 men and women aged more than 15 years, respectively, from four FOTs of Guadeloupe, Martinique, French Guiana, and French Polynesia. Hypertension was defined as blood pressure (BP) at least 140/90 mmHg or the current use of antihypertensive treatment.

Results

The prevalence of hypertension was 29.2% in Guadeloupe, 17.9% in French Guiana, 27.6% in Martinique and 24.5% in French Polynesia. Considering the Guadeloupe population as the reference group, prevalence of hypertension was significantly lower in French Guiana (P < 0.001), even after controlling for age and sex (PU0.006). Awareness and treatment of hypertension were similar in French Guiana, Martinique and Guadeloupe (68.8–75.1% and 69.0–73.4%, respectively). Awareness was lower in French Polynesia (50.0%, adjusted P value U0.04), as was treatment of hypertension (32.4%, adjusted P value U0.001). Control of hypertension was also lower in French Polynesia (8.8%, adjusted P value U0.001) compared with the other territories (29.7–31.8%). French Polynesia had the highest prevalence of obesity (33.1%, adjusted P value < 0.001) as compared with the other territories (17.9–22.8%). It had also the largest population attributable fraction of hypertension due to obesity (35.5%) compared with Guadeloupe (13.3%), Martinique (12.3%) and French Guiana (23.6%).

Conclusion

Wide variations were observed in the prevalence and the management of hypertension between these FOTs, and an especially challenging low control of hypertension was found in French Polynesia. Obesity appears a key target to prevent hypertension, particularly in French Polynesia.     

Corrélations entre antécédents d’angioplastie coronaire et mortalité précoce après chirurgie coronaire

Background

In this study, we examine the effect of previous percutaneous intervention on the rate of adverse perioperative outcome in patients undergoing coronary artery bypass graft surgery (CABG).

Methods

Outcomes of 240 CABG patients, collected consecutively in an observational study, were compared. Gp A (n = 35) had prior PCI before CABG and Gp B (n = 205) underwent primary CABG.

Results

Statistically significant results were obtained for the following preoperative criteria: previous myocardial infarction: 48.6% vs 36.6% (P = 0.003), distribution of CAD (P = 0.0001), unstable angina: 45.7% vs 39% (P = 0.04). For intraoperative data, the total number of established bypasses was 2.6 (GpA) vs 2.07 (Gp B) (P = 0.017), with the number of arterial bypass grafts being: 20% vs 13% (P = ns). Regarding the postoperative course, no significant difference in troponine I rate, 24-hour bleeding: 962 ml (Gp A) vs 798 ml (Gp B) (P = 0.004), transfusion (PRBC unit): 3.63 (Gp A) vs 2.5 (Gp B) (P = 0.006). Previous PCI emerged as an independent predictor of postoperative in-hospital mortality (OR 2.24, 95% CI [1.52–2.75], P < 0.01).

Conclusion

Patients with prior PCI presented for CABG with more severe CAD. Thirty-day mortality and morbidity were significantly higher in patients with prior PCI.     

Résultats diagnostiques à court terme et pronostiques à long terme chez des patients avec syncopes inexpliquées : résultats d’un série menée en centre hospitalier

Objective

Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope.

Method

Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews.

Results

A head-up tilt test was realized in 77 patients (47.8 ± 20 years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32 ± 11 months (range 6–54 months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n = 5/48; 10%) or a negative head-up tilt test response (n = 2/19; 10%).

Conclusion

The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope.     

Prevalence of risk factors for atrial fibrillation and stroke among 1210 patients with sleep disordered breathing

Aims

This study sought to identify the prevalence of risk factors for atrial fibrillation and stroke in a sleep apnea population.

Methods

Study participants included 1210 consecutive adults who were referred with suspicion of sleep apnea. Statistical analysis was used to determine the relationship between sleep apnea syndrome and risk factors for atrial fibrillation and stroke.

Results

Among 1210 enrolled patients, 65.8% had severe sleep apnea (Apnea/hypopnea Index — AHI > 30), 25.2% had mild to moderate sleep apnea (AHI 5 to 30), and 8.8% had no sleep apnea (AHI < 5). At baseline, the mean apnea–hypopnea index in patients with sleep apnea syndrome was 35. Compared to patients with an AHI < 5, those with an AHI > 30 were older (47.3 ± 11.4 vs. 52.74 ± 12.4, p < 0.001) and had a higher body mass index (BMI) (30.7 ± 7.3 vs. 33.83 ± 10.1, p < 0.001), a higher prevalence of hypertension (38 vs. 16%, p < 0.001), and a higher CHADS₂ (congestive heart failure, hypertension, age, diabetes and prior stroke) score (0.59 ± 0.8 vs. 0.28 ± 0.64, p < 0.001).

Conclusions

Patients with severe sleep apnea have a higher prevalence of risk factors for atrial fibrillation and stroke when compared with subjects without sleep apnea.     

Dénervation rénale dans le traitement de l’hypertension artérielle résistante : expérience du CHU de Lyon

Aim

We report the first experience of Lyon's university hospital regarding renal denervation to treat patients with resistant essential hypertension.

Patients and methods

Over a one-year period, 17 patients were treated (12 men, 5 women) with renal denervation. Baseline characteristics were as follows: age 56.5 ± 11.5 years, BMI 33 ± 5 kg/m² and ambulatory blood pressure 157 ± 16/87 ± 13 mmHg with 4.2 ± 1.5 anti-hypertensive treatment.

Results

We did not observe per procedural and early complications. After a median follow-up of 3 months and with the same anti-hypertensive treatment, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decrease respectively of 20 ± 15 (P < 0.001) and 10 ± 13 mmHg (P = 0.014) (n = 17). After six months of follow-up, ambulatory blood pressure (ABPM) decrease of 17.5 ± 14.9 mmHg (P = 0.027) for SBP and of 10.5 ± 9.6 mmHg (P = 0.029) for DBP (n = 6). Among these patients, five of them were controlled (ABPM inferior to 130/80 mmHg) and electrical left ventricular hypertrophy indexes decreased: R wave in aVL lead of 4 ± 3 mm (P = 0.031), Sokolow index of 3 ± 3 mm (P = 0.205), Cornell voltage criterion of 9 ± 7 mm (P = 0.027) and Cornell product of 1310 ± 1104 (P = 0.027).

Conclusion

Our results are in accordance with data from other centers. On average blood pressure decreases significantly but important inter individual variations are observed. The procedure seems safe.     

Association d’une hypertension artérielle rénovasculaire et d’un hyperaldostéronisme primaire

Introduction

Renal artery stenosis is rarely associated with Conn adenoma.

Case report

We report a 27-year-old male patient who presented in 2001 with a severe high blood pressure associated with hypokaliemia. Radiologic investigations showed a left renal artery stenosis with agenesis of left kidney. A left nephrectomy was performed and blood pressure returned to normal with a single antihypertensive drug. Five years later, the patient again presented with severe high blood pressure. Laboratory studies revealed a low serum potassium level at 2.8 mmol/L associated with high urinary potassium excretion (84 mmol/24 h) and a very high aldosterone/renin ratio (> 462). Abdominal CT scan demonstrated a right adrenal mass. The patient underwent a right adrenalectomy (adenoma). Blood pressure returned to normal with a single antihypertensive. Serum potassium levels as well as aldosterone/renin ratio normalized.

Conclusion

We discussed whether the association between these two entities is merely fortuitous or conversely based on a causal relationship.     

L’éducation nutritionnelle du patient coronarien en pratique

Background

The Mediterranean diet is one of the food models which showed its ability at the patient at high cardiovascular risk in numerous cohort studies and two major interventional studies: Lyon Heart Study in 1999 and PREDIMED in 2013.

Aim of the study

Propose a practical assistance in the analysis of the dietary habits of the coronary patient with a simplified food frequency questionnaire.

Patients and methods

Hundred coronary patients followed a program of cardiac rehabilitation and benefited from a nutritional education. The analysis of their dietary habits was made with the questionnaire of frequency of consumption of Rennes upon their arrival and 6 months later. We have coded again these data by means of a simplified questionnaire with 15 items and compared the results and their evolution in 6 months.

Results

On studied 200 questionnaires, the score of Rennes was 10.6 ± 4.5 and the simplified score 8.2 ± 3.4 with a coefficient of correlation of Pearson r = 0.94 (0.91–0.95) at risk P < 0.0001. Initial scores were respectively 8.0 ± 4.4 and 6.3 ± 3.4 (r = 0.93) and the scores at 6 months 13.1 ± 2.9 and 10.1 ± 2.2 (r = 0.86). The evolution of the scores of 100 patients were respectively 14.2 ± 11.7% and 12.6 ± 11% (P < 0.26).

Conclusion

The use of a simplified questionnaire allows to analyze the dietary habits of the coronary patient and to estimate their evolution during a therapeutic educational program.     

Sclérites,aspects cliniques, étiologiques et thérapeutiques : à propos d’une série de 32 observations

Purpose

To report on the various clinical presentations, etiological diagnosis, prognosis and treatment of patients with scleritis evaluated at a tertiary care eye center.

Methods

Retrospective, monocentric study on a series of 32 patients in a tertiary center.

Results

The mean age of included patients with scleritis was 46.8 years (range, 22 to 77 years). Nineteen patients were women and 13 were men. Twenty-six patients (81%) had anterior scleritis (15 nodular, 8 diffuse and 3 necrotizing), six (19%) had posterior scleritis. Unilateral inflammation was present in 24 patients (75%). Twelve out of the 32 patients (37.5%) had an underlying systemic disease: granulomatosis with polyangiitis (n = 3), Behçet's disease (n = 2), unspecified inflammatory arthritis (n = 2), psoriatic arthritis (n = 1), ankylosing spondylitis (n = 1), sarcoidosis (n = 1), Cogan's syndrome (n = 1) and ulcerative colitis (n = 1). Six patients (18.8%) were suspected of having infectious disease with herpes virus: clinical context and positive treatment response with oral valacyclovir. Systemic agents and topical agents were required in 28 patients (87.5%). The first line therapy was mainly oral non-steroidal anti-inflammatory drugs in 15 patients (47%) and oral corticosteroids in 8 (25%). Immunosuppressive drugs were required in 6 patients. The mean follow-up was 16.3 months. Six patients (19%) had a decrease in visual acuity.

Conclusion

The number of systemic disease in our series is similar to the main series in the literature. Treatment with valaciclovir might be effective in patients with suspected herpes simplex scleritis.     

Impact de la modification des prescriptions chez les sujets âgés hospitalisés en service de court séjour gériatrique en termes de coût

Purpose

Polypharmacy in the elderly increases the risk of adverse drug reactions and leads to increased medical costs. There is little data currently available on drug modification and cost reduction during hospitalization in a geriatric unit. The aims of this study were to analyse drug modification during hospitalization in a geriatric care unit and to evaluate the repercussions in terms of cost reduction.

Methods

This monocentric study included 691 patients over a period of 3.5 years. The drugs and their daily costs were counted and classified (10 classes, 37 subclasses) upon admission and upon discharge. The modifications in the number of drugs in each class and subclass, as well as their costs, were analysed. Predictive factors in drug modification between admission and discharge were investigated.

Results

Our study showed a significant decrease in the number of drugs (mean  ±  standard error [SE], 5.2 ± 0.11 to 4.5 ± 0.07), as well as in the daily medical costs (4.4 ± 0.18 to 3.67 ± 0.12 €) between admission and discharge. The higher the number of drugs was upon admission, the greater the reduction was upon discharge. Cardiovascular, metabolic, analgesic and pulmonary drugs were significantly reduced, whereas gastrointestinal and anti-osteoporotic treatments increased. Diabetes, adverse drug events and the one-leg balance were predictive factors in drug modification.

Conclusion

Hospitalization in a geriatric unit allows a re-evaluation of drug management with a significant reduction in the number and cost of treatments between admission and discharge. Given the multiple consequences of polypharmacy and its serious financial impact, research to develop optimal care of the elderly and to improve medication intervention is warranted.     

Particularités cliniques de l’embolie pulmonaire chez la personne âgée : étude comparative de 64 patients

Purpose

To date only a few studies regarding pulmonary embolism (PE) in elderly have been published. The aim of this study was to determine the clinical features of PE in elderly patients (≥ 75 years).

Methods

All patients hospitalized for PE in our internal medicine department from January 2005 to December 2010 were included in the study. The aim was to compare the features of PE in elderly patients (≥ 75 years) to those of patients younger than 75 years. The following data were recorded: past medical history, risk factors for venous thrombo-embolism (VTE), clinical features, and PE etiologies.

Results

The population was composed of 64 patients (women 56%) with a median age of 82 years (IQR: 13.5). There was no statistical difference for risk factors of VTE. Syncope was more frequent in elderly patients (33% versus 7%, P = 0.04) whereas thoracic pain predominated in younger patients (36,5% versus 7%, P = 0.005). Chronic obstructive pulmonary disease was more frequent in the past medical history of elderly patients. The diagnostic of PE was less suspected in elderly patients (47% versus 72%, P = 0.035). The etiologies were similar between the two groups.

Conclusion

Our study highlights the frequency of syncope as the presenting feature of PE in elderly, whereas thoracic pain is uncommon. We confirmed the difficulty to diagnose PE in elderly population.     

Reduced flow-mediated vasodilation of brachial artery in children with primary snoring

Background

Sleep disordered breathing, especially obstructive sleep apnea, is associated with endothelial dysfunction in both adults and children. However, the role of primary snoring (PS) on endothelial function has not been investigated. This study aimed to examine flow-mediated vasodilation (FMD) in both normal weight and overweight children with PS.

Methods

Children aged 6–18 years with habitual snoring were recruited from our sleep disorder clinic. Non-snoring controls were recruited from participants of a community growth survey. All subjects underwent polysomnography and FMD evaluation on the same day. Children with body mass index of greater than the 85th percentile of the local reference were defined as overweight. Subjects were divided into groups of normal weight, overweight, non-snorers and PS for comparisons.

Results

Two hundred and one children, of whom 83 were overweight, with a mean ± SD age of 11.3 ± 2.7 years were recruited. Seventy three out of 201 children had PS. Both normal weight (7.9 ± 1.3 vs. 8.5 ± 0.9, p = 0.012) and overweight subjects (7.4 ± 1.4 vs. 8.1 ± 1.1, p = 0.006) with PS had significantly reduced FMD than the non-snoring controls. Multivariate linear regression model showed that PS was independently associated with reduced FMD in both normal weight (p = 0.014) and overweight subgroups (p = 0.016) after controlling for obstructive apnea hypopnea index.

Conclusions

PS in children is associated with reduced FMD, independent of obesity.     

Amylose cardiaque : à propos d’une série de 14 patients,description et facteurs pronostiques

Purpose

Cardiac amyloidosis is rare. The objective of this study was to report on a case series of 14 patients with cardiac amyloidosis and to study the prognostic factors.

Methods

Monocentric retrospective study of all adult patients who presented with cardiac amyloidosis, diagnosed at the Georges-Pompidou European hospital in Paris between 2003 and 2011.

Results

Fourteen patients were identified (10 men and four women). Median age at diagnosis was 66.5 years. Twelve patients were diagnosed with AL amyloidosis, one with AA amyloidosis, and one with transthyretin amyloidosis. All patients presented cardiac manifestations: heart failure (n = 9), rhythm disorders (n = 6). Eight patients presented extra-cardiac manifestations of amyloidosis: renal (n = 8), gastrointestinal (n = 5). Troponin serum level was increased in eight patients and BNP level was superior to 400 pg/L in 12 patients. When performed, the cardiac magnetic resonance imaging (MRI) showed, in six patients out of seven, chamber dilatation, concentric hypertrophy or late enhancement. Among patients with cardiac failure at diagnosis (n = 9), seven died with a median survival of 1 month duration. Factors of poor prognosis were, in our study, heart failure, elevated levels of troponin and BNP, and the AL amyloidosis subtype.

Conclusion

Cardiac amyloidosis, especially the AL type, has a very poor prognosis, essentially because of an underlying multiple myeloma and heart failure.     

Morbimortalité cardiovasculaires en 6 ans des hypertendus noirs du sud algérien

Introduction

Arterial hypertension is a major public health problem not only internationally, but also in our country, and it is the major risk factor for cardiovascular diseases. In south Algeria, the black population is nearly half the population of the oases of the Algerian Sahara.

The objectives of the study

The objectives of the study are to analyze the long-term fate of the black hypertensive subjects in Algerian oases in southern Algeria, in terms of morbidity and mortality, comparing the morphometric profile and cardiovascular complications with the white population of the same oases.

Materials and methods

One thousand four hundred and twenty-five subjects of both sexes were included (811 blacks and 614 white subjects), aged 40 and older, living in the Algerian Sahara and were reviewed after six years of decline. The control consisted of filling a questionnaire oriented on civil status, target organ damage, the number of hospitalizations and mortality. All calculations and statistical analyzes are processed by the SPSS 17.0 and Epi Info6 software.

Results

Mean age for the black population and the white population was 60.3 ± 11.1 and 58.6 ± 10.6 years, respectively. The incidence of hypertension was 50 % among blacks. The main complications observed were: stroke in 3.8 %, heart failure in 3.1 %, myocardial infarction in 1.7 %, hospitalizations related to cardiovascular complications of the black population was around 4.4 %, mortality 5.4 %.

Conclusion

These data on hypertension black subjects emphasize the importance of a policy of adequate local health issues raised, both in terms of the management of hypertension, as in investment in local medical research.     

Admissions en réanimation des femmes en cours de grossesse ou en post-partum : circonstances et pronostic. Une série rétrospective de 96 cas

Purpose

Very few studies had been published about admission of obstetric patients in French intensive care units (ICU).

Patients and methods

Files of women who had been admitted during pregnancy or the postpartum period to ICU of an academic hospital between January 1st 1997 and 31st December 2006 were analyzed. Diagnosis at admission, severity, main treatments and outcome were studied during two successive periods of 5 years.

Results

There were 96 admissions (0.95% of all admissions to ICU). They included 34 complications due to arterial hypertension (35%), among them 10 cases of pre-eclampsia, eight of eclampsia, seven of Hemolysis-Liver Enzymes-Low Platelet (HELLP) syndrome and two of retroplacental hematoma ; 26 postpartum haemorrhages (27%); and 36 miscellaneous diagnosis including two sepsis, four acute pulmonary oedema, four cardiomyopathy, three pulmonary embolism, and three acute liver steatosis. Mean Simplified Acute Physiologic Score (SAPS II) was 18.5 ± 11.2 and mean Sequential Organ Failure Assessment (SOFA) 2.1 ± 2.3. The main treatments were mechanical ventilation (50% of all cases) and transfusion (32%). The average ICU stay was 5.7 ± 5.4 days. Two maternal deaths were observed (aortic dissection and peripartum cardiomyopathy). The number of patients admitted for postpartum haemorrhage increased from five to 21 over the two successive periods of the study.

Conclusion

The number of women admitted to ICU during pregnancy or the postpartum period is low. Admissions for hemorrhage have increased. Regular monitoring of maternal morbidity and mortality gives relevant clues for assessing the quality of obstetrical care.