A case series describing causes of death in pregnant women with sickle cell disease in a low‐resource setting

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dc.contributor.authorAsare, E.V.
dc.contributor.authorOlayemi, E.
dc.contributor.authorBoafor, T.
dc.contributor.authorDei-Adomakoh, Y.
dc.contributor.authorMensah, E.
dc.contributor.authorOsei-Bonsu, Y.
dc.contributor.authorCrabbe, S.
dc.contributor.authorMusah, L.
dc.contributor.authorHayfron-Benjamin, C.
dc.contributor.authorCovert-Greene, B.et.al.
dc.date.accessioned2019-07-03T11:46:12Z
dc.date.available2019-07-03T11:46:12Z
dc.date.issued2018-07
dc.description.abstractSickle cell disease (SCD) is most prevalent in sub‐Saharan Africa with 15,000 newborns per year in Ghana.1, 2 Pregnant women with SCD have increased risks of both SCD‐specific and pregnancy‐related complications, compared to pregnant women without SCD.3 In a recent meta‐analysis, our team reported that SCD in pregnancy increases the risk of maternal death by over 20‐fold compared to pregnant women without SCD, in low‐ and middle‐income countries.4 In sub‐Saharan Africa, maternal death rate of SCD is 7%‐12%,3, 5, 6 without clearly identifiable etiologies. Following our before and after study that demonstrated a 89% relative risk reduction in maternal death in women with SCD with our combined SCD‐obstetric team care model,7 we undertook a medical records and autopsy review of all SCD maternal deaths over a seven‐year period from 2010 to 2016, at the Korle‐Bu Teaching hospital (KBTH), in Accra, Ghana. Ethical approval was obtained from the institutional review boards of the College of Health Sciences, University of Ghana and Vanderbilt University Medical Centre. At the KBTH, about 11 000 deliveries occurred annually including 200 women with SCD, and about two‐thirds are HbSC. We conducted a combined retrospective (January 2010 to April 2015) and prospective case series (May 2015 to December 2016) of all maternal deaths in women with SCD at KBTH. All deaths that occurred prior to arrival at the hospital, and those without documented evidence of hemoglobin phenotype, were excluded. Our research team, including obstetricians, hematologists, a pediatrician, anesthesiologists and nurses, adjudicated all cases of SCD maternal deaths to reach a consensus on the cause of death. Pathologists performed autopsies. In this series, we defined maternal death, direct and indirect obstetric cause of death according to WHO ICD‐10 classification (WHO 2012).8 The maternal mortality records, patients' admission and discharge files, and death certificates of all SCD‐related maternal deaths within the study period were retrieved and reviewed by the team. Data were summarized as simple descriptive statistics. The Mann‐Whitney U‐test and Fisher exact test were used to evaluate differences between pregnant women with HbSS versus HbSC. A P‐value of < .05 was considered statistically significant. SPSS version 24 (IBM Corp, USA) was used for analysis.en_US
dc.identifier.otherhttps://doi.org/10.1002/ajh.25115
dc.identifier.urihttp://ugspace.ug.edu.gh/handle/123456789/31230
dc.language.isoenen_US
dc.publisherAmerican Journal of Hematologyen_US
dc.titleA case series describing causes of death in pregnant women with sickle cell disease in a low‐resource settingen_US
dc.typeArticleen_US

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