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Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study)
Author(s) -
Maaløe Nanna,
Andersen Camilla B.,
Housseine Natasha,
Meguid Tarek,
Bygbjerg Ib C.,
Roosmalen Jos
Publication year - 2019
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12692
Subject(s) - medicine , confidence interval , apgar score , obstetrics , pregnancy , intervention (counseling) , relative risk , blood pressure , emergency medicine , pediatrics , birth weight , nursing , biology , genetics
Objective To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy ( sHDP ). Methods A pre–post study at Zanzibar's low‐resource Mnazi Mmoja Hospital was conducted. All labouring women with sHDP were included at baseline (October 2014 to January 2015) and at 9–12 months after implementation of the ongoing intervention (October 2015 to January 2016). Background characteristics, clinical practice, and delivery outcomes were assessed by criterion‐based case file reviews. Results Overall, 188 of 2761 (6.8%) women had sHDP at baseline, and 196 of 2398 (8.2%) did so during the intervention months. The median time between last blood pressure recording and delivery decreased during the intervention compared with baseline ( P =0.015). Among women with severe hypertension, antihypertensive treatment increased during the intervention compared with baseline (relative risk [ RR ] 1.37, 95% confidence interval [ CI ] 1.14–1.66). Among the neonates delivered (birthweight ≥1000 g), stillbirths decreased ( RR 0.56, 95% CI 0.35–0.90) and Apgar scores of seven or more increased during the intervention compared with baseline ( RR 1.17, 95% CI 1.03–1.33). Conclusion Although health system strengthening remains crucial, locally tailored clinical guidelines seemed to help work‐overloaded birth attendants at a low‐resource hospital to improve care for women with sHDP . ClinicalTrials.org NCT02318420.