Multidisciplinary care results in similar maternal and perinatal mortality rates for women with and without SCD in a low‐resource setting

Abstract

In Africa, the maternal mortality rate in sickle cell disease (SCD) is~10%. Our team previously demonstrated an 89% decrease in mortality rate in a before-and-after feasibility study among women with SCD living in low-resource setting in Ghana. In the same cohort including additional participants with and without SCD, we used a prospective cohort design to test the hypothesis that implementing a multidisciplinary care team for pregnant women with SCD in low-resource setting will result in similar maternal and perinatal mortality rates compared to women without SCD. We prospectively enrolled pregnant women with and without SCD or trait and followed them up for 6-week postpartum. We tested the newborns of mothers with SCD for SCD. We recruited age and parity matched pregnant women without SCD or trait as the comparison group. Maternal and perinatal mortality rates were the primary outcomes.A total of 149 pregnant women with SCD (HbSS, 54; HbSC, 95) and 117 pregnant women without SCD or trait were included in the analysis. Post-intervention, maternal mortality rates were 1.3% and 0.9% in women with and without SCD, respectively (P = 1.00); the perinatal mortality rates were 7.4% and 3.4% for women with and without SCD, respectively (P = 0.164). Among the mothers with SCD,~15% of newborns had SCD. Multidisciplinary care of pregnant women with SCD may reduce maternal and perinatal mortality rates to similar levels in pregnant women without SCD in low-resource settings. Newborns of mothers with SCD have a high rate of SCD.

Cerebro‐placental ratio as a prognostic factor of fetal outcome in pregnancy complicated by maternal sickle cell disease

“…Perinatal mortality and morbidity such as intrauterine growth restriction (IUGR), preterm delivery, and intrapartum fetal distress are higher in women with SCD than in those without SCD 2–5 . Over the years, improvements in obstetric outcomes have been observed for women with SCD owing to better fetal surveillance and multi‐disciplinary care including hematology 6 …”

Third trimester and early postpartum period of pregnancy have the greatest risk for ACS in women with SCD

“…The definition of acute pain episode as in our previous publications was maintained. 3,4,6 During the postpartum period, "if the patient was able to judge whether the pain was of the type usually associated with crisis and reported such pain, this was considered appropriate evidence of an acute pain episode. 5 " The total number of acute pain episodes requiring hospitalization was confirmed with a chart review.…”

“…The definition of ACS as in our previous publications was maintained. 3,4,6 The research obstetricians and hematologists adjudicated all participants admitted for suspected ACS events. A consensus agreement was reached to determine the diagnosis of ACS.…”

“…During the pregnancy period, outpatient and inpatient care were provided by our multidisciplinary care team as previously described. 4 All participants in the pregnancy cohort were referred to the adult SCD clinic; however, some elected not to attend because they received their routine care outside of GICG. Sixty-six percent of the study participants were attendants at the adult sickle cell clinic during the postpartum period and were evaluated every 3 months by hematologists, general practitioners or both.…”

“…Standard care protocols were used during acute pain episodes depending on pain rating. 3,4,6 Using either the numeric or descriptive scales, participants who had reduction in pain intensity to mild pain (1/10-3/10) were discharged and asked to come for follow-up the next day. Participants with persistently moderate (4/10-6/10) or severe (>6/10) pain after 6 hours observation period were referred to the medical emergency for further management.…”