Résumé
The aim of this study was to examine referral practices for critical parturients in French type 2 and 3 obstetric units, using a mixed-method approach combining a quantitative survey based on clinical vignettes and semi-structured interviews. Results: the study, which gathered responses from 80 obstetric units and interviewed 22 anesthesiologists across France, revealed significant variability in the definition of critical parturients and in referral practices. The intent to refer to intensive care ranged from 2% to 92%. There was a statistically significant difference in referral intentions between the prepartum and postpartum periods. Only 7.5% of the surveyed centers had obstetric critical care beds. The type of maternity unit, the availability of a 24/7 PACU (Post-Anesthesia Care Unit), and university hospital status significantly influenced the intent to refer to intermediate care units (ICU). Barriers to ICU referral were identified, including difficulties in maintaining fetal monitoring outside the maternity ward, prioritization of surgical activities in critical care beds, and the lack of intensive care team training in obstetrics. Suggestions for improvement included the implementation of protocols and decision aids, an increase in obstetric critical care beds, and multidisciplinary training for managing these clinical situations. Conclusion: this study reveals major disparities in referral practices for critical parturients in France, linked to the specificity of this specialty, underlining the need for specific reflection at obstetric unit level and national level.