Creating hospital teams devoted to treating pregnant women who have sickle cell disease reduced death rates for those women by almost 90 percent, a study at a major hospital in Ghana showed.
Sickle cell disease is common in West Africa and among black people in the Americas whose ancestors came from West Africa. It is caused by a genetic mutation that if inherited from only one parent protects against malaria, but if inherited from both parents can be lethal. Red blood cells can collapse into curved "sickle" shapes and clump together to jam capillaries, sometimes causing excruciating pain, shortness of breath and death.
At the Korle-Bu Teaching Hospital in Accra, the capital of Ghana, women with sickle cell disease were about 12 times as likely to die in childbirth as women without it, according to a study presented last month at the American Society of Hematology.
To overcome that, the hospital formed teams of nurses, obstetricians and blood and lung specialists and assigned them to care for all pregnant women with the disease. If the women suffered serious pain or breathing crises, and when they began labor, they got beds in wards overseen by the team.
With help from a U.S. team led by Dr. Michael DeBaun, a pediatric hematologist who directs the Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Korle-Bu adopted proven care protocols. Those included giving transfusions before cesarean sections and treating women experiencing chest pain by having them take deep breaths and blow hard, which helps prevent lung collapse.
Because Korle-Bu could not afford spirometers, patients were taught to blow up balloons, DeBaun said. The hospital was given some fingertip sensors that measured how much oxygen was in the blood.
After the teams and protocols were in place, the hospital's rate of maternal deaths in childbirth for women with sickle cell disease dropped to 1.1 percent from 9.7 percent. Also, the women suffered only about one-quarter as many episodes of severe chest or joint pain. Deaths of babies also dropped by about one-third.
New York Times
