Premium
Implementation of multidisciplinary care reduces maternal mortality in women with sickle cell disease living in low‐resource setting
Author(s) -
Asare Eugenia Vicky,
Olayemi Edeghonghon,
Boafor Theodore,
DeiAdomakoh Yvonne,
Mensah Enoch,
Ghansah Harriet,
OseiBonsu Yvonne,
Crabbe Selina,
Musah Latif,
HayfronBenjamin Charles,
Covert Brittany,
Kassim Adetola A.,
James Andra,
Rodeghier Mark,
DeBaun Michael R.,
Oppong Samuel A.
Publication year - 2017
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.24790
Subject(s) - medicine , pregnancy , psychological intervention , obstetrics , obstetrics and gynaecology , mortality rate , prenatal care , pediatrics , emergency medicine , population , nursing , biology , genetics , environmental health
Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low‐resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low‐resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before‐and‐after study, at the Korle‐Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric‐hematology care team for women with SCD in a combined SCD‐Obstetric Clinic. The pre‐intervention period was assessed through a retrospective chart review to identify every death and the post‐intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre‐ and post‐ intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre‐intervention to 1176 per 100 000 at post‐intervention, representing a risk reduction of 89.1% ( P = 0.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre‐intervention to 23.0 per 1000 at post‐intervention, representing a risk reduction of 62.2% ( P = 0.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low‐resource setting.