Abstract
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.
| Original language | English |
|---|---|
| Journal | International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics |
| Volume | 144 |
| Issue number | 1 |
| Pages (from-to) | 27-36 |
| Number of pages | 10 |
| ISSN | 0020-7292 |
| DOIs | |
| Publication status | Published - Jan 2019 |