Assessment of clinical management of women with pre-eclampsia with severe features and maternal and fetal outcomes at Amana hospital in Dar es salaam Tanzania

Abstract

ABSTRACT Background: Pre-eclampsia with severe features (PEWSF) is a serious complication of pregnancy have significant contribution to maternal morbidity and mortality, particularly in resource-limited settings. Despite the availability of the management guidelines, many hospitals face challenges in managing these conditions. The clinical guideline in management of PEWSF was recent introduced. The adherence to clinical guideline is critical particular to low and middle income countries due to shortage of nursing staff. However the adherence of the guideline is not well known. Understanding the current practices and adherence to clinical guidelines is crucial that may help to identify areas for improvement in the management of pre-eclampsia with severe features (PEWSF), ultimately contributing to enhanced maternal healthcare outcomes. Adherence to clinical guidelines is critical. It might also highlight specific challenges faced in resource-limited settings, providing a clearer rationale for the study Aim of study: To determine the association between adverse maternal and fetal outcome and clinical management of women with PEWSF at Amana Regional Referral Hospital. Materials and Methods: Hospital-based retrospective cohort study was employed a total 200 patients’ files diagnosed with PEWSF from 1st January 2023 to 31st December 2023.At Amana Regional Referral Hospital. Simple random sampling technique was utilized to select the cases; Assessment was done by extraction of information from both patients’ files and Hospital electronic database. Obtained data were summarized and analyzed using Statistical Package for Social Science (SPSS) program version 27. Results: Results: The prevalence of adherence to clinical guidelines was found to be 25 (12.5%), with adherence rates varying across different guideline components: maternal and fetal management 117 (58.5%) and monitoring maternal and fetal wellbeing and follow-up management 131 (65.5%), while a small prevalence adhered to assessment of maternal and fetal 69 (34.5%). Adverse fetal outcome: those children with gestational age ≥ 37 weeks and above had lower odds of adverse fetal outcome (95% CI: 1.469–7.741, p =.004) compared with gestational age below 37 weeks. There were high rates of fetal complications (52.5%), and prematurity (21.5%) was the most common complication identified. xiii Conclusion: The study highlights significant challenges in adhering to clinical guidelines for managing PEWSE, with poor adherence. Gestational age 37 and above was protective from fetal complications. There is a need to place emphasis on regular education sessions for healthcare providers on the implementation of the clinical management guidelines in the management of pre-eclampsia with severe features (PEWSF) Key words; Adherence to guideline, adverse maternal, PEWSF, clinical management