Presentation, Management and Pregnancy Outcomes of Rheumatic Diseases in Pregnancy at Kenyatta National Hospital From April 2010 Tooctober 2022: (a Descriptive Cross-sectional Study)

Abstract

Background: Rheumatic disease (RD) is prevalent in women of child bearing age and associated with several negative outcomes in pregnancy results, for example, preterm births, hypertensive disorders and increased risk for Cesarean delivery. However, the advancement in the treatment of the condition has had marked improvement in the conditions’ management. Despite this, gaps exist in knowledge, practice, and policies on the same in Kenya which the study will fill. Broad Objective: To evaluate the presentation, treatment and pregnancy outcomes for women managed for rheumatic disease (lupus, rheumatoid arthritis and scleroderma) in pregnancy at Kenyatta National Hospital (KNH) in the period of 2010-2022. Methodology: This was a descriptive cross-sectional study based on data from the patients’ files. The study was conducted at KNH. The study involved a cohort of women managed for rheumatic disease (lupus, rheumatoid arthritis, and scleroderma) in pregnancy at KNH, 2010-2022. The targeted sample size was 41. Data was analyzed using SPSS v. 25, and presented in charts, tables and graphs. Results: The study targeted a sample of 41 case files, but after filtering through 1200 files for women with rheumatic disease who were seen at KNH between 2010 and October 2022, only 30 patient files met the eligibility criteria. The mean maternal age was M = 31.70 years (SD = 4.617). A majority of the patients were married or cohabitating (73.3%, N = 22). Unemployed ranked highest (46.7%, N = 14) in occupation categorization. The sample had a significant proportion of history of miscarriage 40.0% (N = 12). Most prevalent RD was systemic lupus erythematosus (SLE) at 63.33% (N = 19), followed by antiphospholipid 26.67% (N = 8), Rheumatoid arthritis 20.0% (N = 6), mixed connective tissue disease (MCTD) 6.67% (N = 2), and scleroderma 3.33% (N = 1) with no case for undifferentiated connective tissue disease (UCTD). Constitutional symptoms were observed in 93.3% (N= 28), joint-related symptoms occurring in 73.3% (N = 22), hematological involvement were reported in 60.0% (N = 18), and (26.67%, N = 8) cases presented with pleural and/or cardiac effusion while mucocutaneous involvement symptoms were noted in 23.33% (7 = N). Immunological findings indicated that all SLE had a positive ANA test results, 21.1% had positive anti RA results, 15.8% had anti RO positive test, and 5.3% had ENA positive. All those with RA had positive RF test results. Post-delivery admission (70.0%, N = 21), pre-eclampsia with severe features (50.0%, N = 15), pre-delivery admissions (46.7%, N = 14), and flaring (36.7%, N = 11), CS delivery 40.0% (N = 12), premature rupture of membranes 26.7% (N = 8), ICU admissions 23.3% (N = 7), PPH 20.0% (N = 6), alopecia (10%, N = 3) and oral ulcers (10%, N = 3) were the main adverse maternal outcomes. The main adverse perinatal outcomes noted included fetal loss (including stillbirth) 46.7%, (N = 14), prematurity 23.3% (N = 7), fetal growth restriction 20.0% (N = 6), and NICU admission 16.7% (N = 5)...