Guidelines for the management of urgent obstetric situations in emergency medicine, 2022

Gilles Bagou; Loïc Sentilhes; Frédéric J Mercier; Paul Berveiller; Julie Blanc; Eric Cesareo; Pierre-Yves Dewandre; Bénédicte Douai; Aurélie Gloaguen; Max Gonzalez; Philippe Le Conte; Agnès Le Gouez; Hugo Madar; Emeline Maisonneuve; Estelle Morau; Thibaut Rackelboom; Mathias Rossignol; Jeanne Sibiude; Julien Vaux; Alexandre Vivanti; Sybille Goddet; Patrick Rozenberg; Marc Garnier; Anthony Chauvin

doi:10.1016/j.accpm.2022.101127

Guidelines for the management of urgent obstetric situations in emergency medicine, 2022

Anaesth Crit Care Pain Med. 2022 Oct;41(5):101127. doi: 10.1016/j.accpm.2022.101127. Epub 2022 Aug 5.

Authors

Gilles Bagou¹, Loïc Sentilhes², Frédéric J Mercier³, Paul Berveiller⁴, Julie Blanc⁵, Eric Cesareo⁶, Pierre-Yves Dewandre⁷, Bénédicte Douai⁸, Aurélie Gloaguen⁹, Max Gonzalez¹⁰, Philippe Le Conte¹¹, Agnès Le Gouez³, Hugo Madar², Emeline Maisonneuve¹², Estelle Morau¹³, Thibaut Rackelboom¹⁴, Mathias Rossignol¹⁵, Jeanne Sibiude¹⁶, Julien Vaux¹⁷, Alexandre Vivanti¹⁸, Sybille Goddet¹⁹, Patrick Rozenberg⁴, Marc Garnier²⁰, Anthony Chauvin²¹

Affiliations

¹ SAMU-SMUR of Lyon, University Hospital Edouard Herriot, Lyon, France. Electronic address: [email protected].
² Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France.
³ Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France.
⁴ Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France.
⁵ Gynaecology and Obstetrics Department, University Hospital Hôpital Nord, Marseille, France.
⁶ SAMU-SMUR 69, University Hospital Hospices Civils de Lyon, Lyon, France.
⁷ Department of Anaesthesiology and Critical Care Medicine, University hospital of Liège, Liège, Belgium.
⁸ SAMU-SMUR 92, University Hospital Beaujon, Clichy, France.
⁹ Emergency Department, Hospital William Morey, Chalon-sur-Saone, France.
¹⁰ Department of Anaesthesiology and Critical Care Medicine in Gynaecology and Obstetrics, University Hospital Jeanne de Flandre, Lille, France.
¹¹ Emergency Department, University Hospital of Nantes, Nantes, France.
¹² Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
¹³ Department of Anaesthesiology, Critical Care, Pain and Emergency, University hospital Carémeau, Nîmes, France.
¹⁴ Department of Anaesthesiology and Critical Care Medicine, University Hospital Pellegrin, Bordeaux, France.
¹⁵ University Paris Cité - APHP Nord, Department of Anaesthesiology and Critical Care Medicine, University Hospital Lariboisière, Paris, France.
¹⁶ Gynaecology and Obstetrics Department, University Hospital Louis Mourier, Colombes, France.
¹⁷ SMUR 94, University Hospital Henri Mondor, Créteil, France.
¹⁸ Gynaecology and Obstetrics Department, Antoine Béclère University Hospital, Clamart, France.
¹⁹ SAMU-SMUR 21 and Emergency Department, University Hospital of Dijon, Dijon, France.
²⁰ Sorbonne University, GRC29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France.
²¹ SAMU-SMUR 75 and Emergency Department, Lariboisière University Hospital, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France.

PMID: 35940033
DOI: 10.1016/j.accpm.2022.101127

Abstract

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.

Keywords: Emergency; Obstetrics; Postpartum.

Publication types

Practice Guideline

MeSH terms

Anesthesiology*
Critical Care
Emergencies
Emergency Medicine*
Female
Heart Arrest* / therapy
Humans
Pregnancy