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Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study)

Maaløe, Nanna ; Andersen, Camilla B. ; Housseine, Natasha ; Meguid, Tarek ; Bygbjerg, Ib C. and van Roosmalen, Jos (2019) In International Journal of Gynecology and Obstetrics 144(1). p.27-36
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... (More)

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.

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Birth asphyxia, Guidelines, Labor, PartoMa, Pre-eclampsia, Severe hypertensive disorders, Stillbirth, Tanzania
in
International Journal of Gynecology and Obstetrics
volume
144
issue
1
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:30307609
  • scopus:85055551298
ISSN
0020-7292
DOI
10.1002/ijgo.12692
language
English
LU publication?
no
id
f7b2f936-9529-43b7-9c51-155cb6c38990
date added to LUP
2018-12-18 08:15:37
date last changed
2020-10-27 01:18:18
@article{f7b2f936-9529-43b7-9c51-155cb6c38990,
  abstract     = {<p>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.</p>},
  author       = {Maaløe, Nanna and Andersen, Camilla B. and Housseine, Natasha and Meguid, Tarek and Bygbjerg, Ib C. and van Roosmalen, Jos},
  issn         = {0020-7292},
  language     = {eng},
  number       = {1},
  pages        = {27--36},
  publisher    = {Elsevier},
  series       = {International Journal of Gynecology and Obstetrics},
  title        = {Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study)},
  url          = {http://dx.doi.org/10.1002/ijgo.12692},
  doi          = {10.1002/ijgo.12692},
  volume       = {144},
  year         = {2019},
}