Asare Eugenia Vicky, Olayemi Edeghonghon, Boafor Theodore, Dei-Adomakoh Yvonne, Mensah Enoch, Ghansah Harriet, Osei-Bonsu Yvonne, Crabbe Selina, Musah Latif, Hayfron-Benjamin Charles, Covert Brittany, Kassim Adetola A, James Andra, Rodeghier Mark, DeBaun Michael R, Oppong Samuel A
Ghana Institute of Clinical Genetics, Korle-Bu, Accra, Ghana.
Department of Hematology, College of Health Sciences, University of Ghana, Accra, Ghana.
Am J Hematol. 2017 Sep;92(9):872-878. doi: 10.1002/ajh.24790. Epub 2017 Jun 9.
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.
镰状细胞病（SCD）与不良妊娠结局相关。在生活于资源匮乏地区的患有SCD的女性中，妊娠与孕产妇和围产期死亡率显著增加有关。我们检验了这样一个假设：在资源匮乏地区组建一个多学科产科和血液科护理团队将显著降低孕产妇和围产期死亡率。我们在加纳阿克拉的科勒-布教学医院进行了一项前后对照研究，以评估在综合性SCD-产科诊所中为患有SCD的女性设立的多学科产科-血液科护理团队的效果。通过回顾性病历审查评估干预前阶段以确定每一例死亡情况，干预后阶段则进行前瞻性评估。干预措施包括产科医生和血液科医生联合进行门诊和急性住院患者评估、密切监测孕产妇和胎儿情况，以及针对急性胸部综合征和急性疼痛发作的简单处理方案。主要结局包括研究期间前后的孕产妇和围产期死亡率。在干预前和干预后阶段，分别对158名和90名患有SCD的孕妇进行了评估。孕产妇死亡率从干预前每10万例活产中的10791例降至干预后每10万例中的1176例，风险降低了89.1%（P = 0.007）。围产期死亡率从干预前每1000例总出生中的60.8例降至干预后每1000例中的23.0例，风险降低了62.2%（P = 0.20）。多学科产科和血液科团队方法可在资源匮乏地区显著降低孕产妇和围产期死亡率。
