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Practice Guideline
. 2022 Oct;41(5):101127.
doi: 10.1016/j.accpm.2022.101127. Epub 2022 Aug 5.

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

Gilles Bagou  1 , Loïc Sentilhes  2 , Frédéric J Mercier  3 , Paul Berveiller  4 , Julie Blanc  5 , Eric Cesareo  6 , Pierre-Yves Dewandre  7 , Bénédicte Douai  8 , Aurélie Gloaguen  9 , Max Gonzalez  10 , Philippe Le Conte  11 , Agnès Le Gouez  3 , Hugo Madar  2 , Emeline Maisonneuve  12 , Estelle Morau  13 , Thibaut Rackelboom  14 , Mathias Rossignol  15 , Jeanne Sibiude  16 , Julien Vaux  17 , Alexandre Vivanti  18 , Sybille Goddet  19 , Patrick Rozenberg  4 , Marc Garnier  20 , Anthony Chauvin  21
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Free article
Practice Guideline

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

Gilles Bagou et al. Anaesth Crit Care Pain Med. 2022 Oct.
Free article

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.

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