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. 2023 Aug 12;23(1):580.
doi: 10.1186/s12884-023-05888-9.

Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone-a registry based evaluation

Milena Mortara  1   2 , Momoh Sitta Turay  2 , Sonia Boyle  2 , Claudia Caracciolo  2   3 , Sarjoh Bah  2 , Henry Kargbo  2 , Eva Hanciles  4 , Valerie John-Cole  2 , Ester Scapini  5 , Roberto Benoni  3 , Vishmi Dissanayake  6 , Abi Beane  6 , Rashan Haniffa  6 , Adeniji O Adetunji  2 , Williamson Taylor  2 , Luigi Pisani  7   8   9
Affiliations

Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone-a registry based evaluation

Milena Mortara et al. BMC Pregnancy Childbirth. .

Abstract

Introduction: Sickle cell disease (SCD) in pregnancy is associated with worse maternal and neonatal outcomes. There is limited available data describing the burden and outcomes of critically ill obstetric patients affected by SCD in low-income settings.

Objectives: We aimed to define SCD burden and impact on mortality in critically-ill obstetric patients admitted to an urban referral hospital in Sierra Leone. We hypothesized that SCD burden is high and independently associated with increased mortality.

Methods: We performed a registry-based cross-sectional study from March 2020 to December 2021 in the high-dependency unit (HDU) of Princess Christian Maternity Hospital PCMH, Freetown. Primary endpoints were the proportion of patients identified in the SCD group and HDU mortality. Secondary endpoints included frequency of maternal direct obstetric complications (MDOCs) and the maternal early obstetric warning score (MEOWS).

Results: Out of a total of 497 patients, 25 (5.5%) qualified to be included in the SCD group. MEOWS on admission was not different between patients with and without SCD and SCD patients had also less frequently reported MDOCs. Yet, crude HDU mortality in the SCD group was 36%, compared to 9.5% in the non SCD group (P < 0.01), with an independent association between SCD group exposure and mortality when accounting for severity on admission (hazard ratio 3.40; 95%CI 1.57-7.39; P = 0.002). Patients with SCD had a tendency to longer HDU length of stay.

Conclusions: One out of twenty patients accessing a HDU in Sierra Leone fulfilled criteria for SCD. Despite comparable severity on admission, mortality in SCD patients was four times higher than patients without SCD. Optimization of intermediate and intensive care for this group of patients should be prioritized in low-resource settings with high maternal mortality.

Keywords: High dependency unit; Low-resource settings; Obstetric; Sickle cell disease.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Boxplot of modified early obstetric warning score and hemoglobin levels in patients with SCD as compared to patients without SCD. P-Value was computed through Mann–Whitney U test. Abbreviations: ns, non significant; MEOWS, modified early obstetric warning score; Hb, hemoglobin
Fig. 2
Fig. 2
Survival curve for the SCD group as compared to the general HDU population. Abbreviations. SCD, sickle cell disease group; HDU high dependency unit
Fig. 3
Fig. 3
Divergent bar plot showing the crude HDU mortality rate stratified by maternal early obstetric warning score and hemoglobin levels. Abbreviations: SCD, sickle cell disease; HDU, high dependency unit; MEOWS, modified early obstetric warning score
See this image and copyright information in PMC

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