692: Improved perinatal outcomes with fetal monitoring in Ghana

Abstract

692 Improved perinatal outcomes with fetal monitoring in Ghana Frank Anderson, Joseph Seffah, Jocelynn Owusu, Mark Chames, Jerry Coleman University of Michigan, Obstetrics and Gynecology, Ann Arbor, MI, University of Ghana, OBGYN, Accra, University of Michigan Medical Center, Obstetrics and Gynecology, Division of MaternalFetal Medicine, Ann Arbor, MI, University of Ghana, Obstetrics and Gynecology, Accra, Ghana OBJECTIVE: To evaluate the effects of NST on perinatal outcomes in hypertensive disease in Ghana, where electronic fetal monitoring is not routine. STUDY DESIGN: A modified fetal assessment center was established at a major teaching hospital in June 2010. From May 2010 to July 2011, 316 women with preeclampsia or PIH were followed from admission to delivery. PIH was defined as Systolic blood pressure (SBP) 140 mmHg or diastolic blood pressure (DBP) 90 mmHg; preeclampsia included the presence of proteinuria 0.3 grams. Exposure to NST and fetal outcomes were recorded. Prevalence of of Apgar5 7, unexpected stillbirth, and early neonatal mortality were compared for the monitored an unmonitored group. An unexpected stillbirth was defined as a fetus admitted to the hospital live but died in utero. RESULTS: Patients in the unmonitored group received routine care which consisted of ausculation of the fetal heart rate in the antepartum and intrapartum period. Monitored patients received antepartum monitoring. Intrapartum monitoring was per routine. Preliminary results are from 164 unmonitored and 154 monitored patients. There was no significant differences in in gravidity (3.07 / 2.20 vs. 3.16 / 1.85), Parity (1.46 / 1.57 vs. 1.49 / 1.50), SBP (156 / 22 vs. 153 / 21), DBP(101 / 18 vs. 98 / 15). Age (30 / 6.0 vs. 32.8 / 5.6) and gestational age (36.9 / 3.7 vs. 35.6 / 3.3) were statistically different between the two groups (p 0.01). PIH cases had no difference in apgar5 7 (5.7% vs. 4.5%; p 0.54); while 21.6% of infants of unmonitored preeclamptic mothers had Apgar5 7, cf 5.1% in the monitored group (p 0.01). Unexpected stillbirth occurred in 9.2% of unmonitored preeclamptic cases and 3.6% of monitored cases (p 0.11). Perinatal death occurred in 10% of the unmonitored preeclamptic group and 2.5% of the monitored preeclamptic group (p 0.05). CONCLUSION: The introduction of antepartum testing for women with Preeclampsia might significantly reduce perinatal mortaliy in low resource settings and should be adapted to low resource settings to decrease mortality.