This article is more than 5 years old. Information may no longer be current.
Multidisciplinary approach for pregnant women with sickle cell disease reduces maternal, perinatal mortality
Click Here to Manage Email Alerts
SAN DIEGO — A multidisciplinary team approach toward care for pregnant women with sickle cell disease markedly decreased maternal and perinatal mortality in a low- and middle-income setting in Ghana, according to results of a prospective study presented at the ASH Annual Meeting and Exposition.
“We saw a dramatic drop — close to a 90% reduction — in maternal deaths, which is really remarkable,” Eugenia Vicky Naa Kwarley Asare, MBChB, BSc, of Ghana Institute of Clinical Genetics and the department of hematology at Korle-Bu Teaching Hospital in Ghana, said in a press release. “Sickle cell disease has acute and chronic complications, and to manage it well — especially in the context of pregnancy and childbirth, you need to have a number of specialists onboard, including a hematologist.”
An estimated 300,000 children are born each year with sickle cell disease, and more than 79% of these births occur in sub-Saharan Africa.
Pregnant women with sickle cell disease are at elevated risk for morbidity and mortality.
At Korle-Bu Teaching Hospital — a national referral center in Accra, Ghana — estimated maternal mortality ratios are 8,300 per 100,000 live births for women with sickle cell disease and 690 per 100,000 live births for women without the condition.
In 2015, hospital staff formed a multidisciplinary obstetric team that included obstetricians with expertise in high-risk pregnancies, as well as hematologists, pulmonologists anesthesiologists and nurses. Protocols also established regular team meetings to allow for discussion of complex patients and increase the likelihood that acute problems could be prevented or addressed quickly.
Asare and colleagues used a before-and-after study design to evaluate whether implementation of this team decreased maternal mortality.
The analysis included a preintervention period from January 2014 through April 2015, during which they reported 158 deliveries among women with sickle cell disease (median age, 29 years; range, 18-43). These women received standard care, primarily from their obstetrician, and they were admitted to multiple wards throughout the hospital.
The postintervention period — May 2015 through May 2016 — included 90 deliveries among women with sickle cell disease (median age, 29 years; range, 18-41).
These women were admitted primarily to two designated wards in the obstetrics department. They received care from the multidisciplinary team at enrollment, during all outpatient visits and when acute issues arose. Follow-up continued for 6 weeks postpartum.
Team members implemented protocols designed to prevent and treat acute chest syndrome. Balloons — used instead of incentive spirometry devices — were used routinely for management of acute pain episodes, as well as after surgery. Pulse oximetry machines were incorporated into routine clinical practice to monitor oxygen desaturation, and team members also implemented close maternal and fetal monitoring.
Maternal mortality rates declined 89%, from 9.5% in the preintervention period to 1.1% in the postintervention period. Asare and colleagues reported maternal mortality ratios of 10,949 per 100,000 live births in the preintervention period and 1,163 per 100,000 live births in the postintervention period.
Perinatal mortality rates declined 62%, from 60.8 per 1,000 total births in the preintervention period to 23 per 1,000 total births in the postintervention period.
The most common causes of death in the preintervention period were cardiopulmonary disease (60%), severe anemia (20%), and pre-eclampsia, acute kidney injury and hypovolemic shock (6.6% each). The only study participant who died in the postintervention study died of a massive pulmonary embolism 4 days after giving birth.
The lack of coordinated care and tracking of women during the preintervention period meant some data were incomplete, limiting comparisons between the two groups. However, Asare and colleagues intend to expand the multidisciplinary approach.
“Our future prospect is to implement a similar program at three major [hospitals] in Ghana,” Asare said during a press conference. “Then we will go a step further to try to identify risk factors for perinatal death and adverse outcomes.” – by Mark Leiser
Reference: Asare EVNK, et al. Abstract 1017. Presented at: ASH Annual Meeting and Exposition; Dec. 3-6, 2016; San Diego.
Disclosure: Asare reports research funding from Vanderbilt University Medical Center Gift Funds and Intramural University of Ghana Research Fund. Please see the abstract for a list of all other researchers’ relevant financial disclosures.