Maternal intra- and postpartum near-miss following assisted reproductive technology: a retrospective study.

OBJECTIVE: To assess whether risk of severe maternal morbidity at delivery differs for women who conceived using assisted reproductive technology (ART), compared with those with a spontaneous conception. DESIGN: A cohort study using a prospectively maintained institutional database. SETTING: A tertiary university maternity hospital. POPULATION: All women delivering at Del Ponte Hospital, Italy, between 2005 and 2016. METHODS: Data from 650 ART-conceived pregnancies were compared with 22 803 spontaneously conceived pregnancies. We used multivariable analysis to estimate the odds of severe maternal morbidity at delivery associated with ART conception, adjusting for maternal demographic and health factors, gestational age, and mode of delivery. MAIN OUTCOME MEASURES: The World Health Organization criteria for potentially life-threatening conditions and near-miss maternal mortality were used. RESULTS: The incidence of near-miss in the entire cohort was 3.3 cases per 1000 births (95% confidence interval, 95% CI, 2.6-4.1). The crude prevalences of potentially life-threatening conditions and maternal near-miss were higher among ART than among non-ART deliveries (27.1 versus 5.7% and 2.6 versus 0.3%, respectively). The three most common causes of maternal near-miss cases were peripartum hysterectomy, transfusion of ≥5 units of red blood cells, and cardiovascular dysfunction requiring vasoactive drugs. The odds of a maternal near-miss at delivery were increased for ART-conceived pregnancies compared with non-ART-conceived pregnancies (adjusted odds ratio, aOR 3.61, 95% CI 1.61-8.09, for ART-conceived pregnancies with autologous oocytes; aOR 13.57, 95% CI 5.45-33.77, for ART pregnancies conceived with donor oocytes). CONCLUSION: Although we cannot exclude unmeasured confounding, we found that pregnancies conceived via ART, especially those conceived with donor oocytes, are at increased risk of maternal potentially life-threatening conditions and near-miss at delivery. FUNDING: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. TWEETABLE ABSTRACT: Conceiving through assisted reproductive technology increases the likelihood of maternal near miss.

[Comparison of SAPS II, MPM II24 and SAPS in intensive care]. / Confronto fra SAPS II, MPM II24 e SAPS in terapia intensiva.

OBJECTIVE: To compare the performance of the new SAPS II, new MPM2 and SAPS in a cohort of patients admitted to our polyvalent ICU. DESIGN: the ability of the SAPS II scoring system to predict the probability of hospital mortality was assessing calibration and discrimination (ROC curve) measures obtained using published coefficients and within relevant subgroups using formal statistic assessment (goodness of fit). PATIENTS: from May 1997 to May 1998, 420 consecutive patients over 18 years old. RESULTS: When the parameters based on the standard model were applied, the SAPS II discrimination (area under ROC curve) was = 0.889 and calibration (chi square test) of SAPS II was = 4.448 with p = 0.879; MPM2 chi 2 = 0.9385, p = 0.402 and SAPS chi 2 = 27.089, p = 0.0001. The performance of SAPS II model was very good. Worst predictive accuracy was achieved in trauma and elective surgery patients. CONCLUSIONS: SAPS II model gave good results in terms of calibration and discrimination. SAPS II has better accuracy then SAPS and MPM2. Concerning the performance of models, large differences were apparent in relevant subgroups: trauma and sepsis patients. Moreover the choice of adequate statistic method to compare intensive care populations appeared to need more research.

[Septic pancreatic necrosis in intensive care]. / La necrosi pancreatica infetta in terapia intensiva.

BACKGROUND: Infected necrotizing pancreatitis is the most fulminant variety of this disease. The reported mortality is up to 50%. The haemodynamic features of cardiovascular instability has many similarities to sepsis syndrome, septic shock and multiple organ dysfunction syndrome (MODS). The purpose of this study is to review personal experience in the ICU (hospital of Varese) to determine etiology, treatment and complications. METHODS: Twenty patients treated since 1988 with infected necrotizing pancreatitis required surgical treatment and mechanical ventilation. RESULTS: The mortality rate was 60% and ICU-stay was 26.5 +/- 12.3 days, the median age was 54 +/- 13. Ranson's criteria at admission to the ICU was 6.6 +/- 1.2, Glasgow point was 4.6 +/- 1.2 (5.5 +/- 0.87 died, 3.2 +/- 0.8 survived p < 0.01), Baltazar score 6.2 +/- 2.1 (7.4 +/- 2.1 died, 5.5 +/- 0.9 survived p < 0.05) and SAPS II score 43.4 +/- 12.1 (50.1 +/- 7.8 died, 34 +/- 5.5 survived p < 0.01). The etiology was: gallstones (45%), alcoholism (15%), ERCP (15%) and idiopathic in 25%. Serum pancreatic amylase was 342 +/- 113.9 U/l (550 +/- 100 died, 155 +/- 60 survived p < 0.01), lipase was 334 +/- 176 U/l and transaminases GOT was 123 +/- 46 u/l (156 +/- 90 died, 29 +/- 7 survived p < 0.05). High initial amylase and GOT levels were frequently found in non survived patients. MODS occurred in 17 cases (85%), ARDS in 2 patients (10%), abdominal bleeding in 6 (30%) and septic syndrome in 8 (40%). CONCLUSIONS: It is thus possible that a target-oriented approach including fluid replacement, rapid correction of intestinal underperfusion, inotropic and antibiotic therapy, supply of specific nutrients and other therapeutic strategies as open laparostomy must be employed to prevent MODS or septic syndrome in pancreatic infection after acute necrotizing pancreatitis.