Impact of Preconception Evidence Based Nursing Guideline on Pregnancy Outcome for Systemic Lupus Erythematosus Women

Abstract

Abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease, primarily affecting young females. Pregnancy in a woman with SLE endures a high-risk situation with increased incidence of maternal and fetal mortality and morbidity. Aim of the study was to evaluate the impact of preconception evidence based nursing guideline on pregnancy outcome for SLE women. A quasi experimental design was utilized to conduct this study. This study was conducted at Rheumatology, Immunology and antenatal clinic for high risk group in addition to labor room at Ain Shams Maternity University Hospital. A purposive sample of 83 women diagnosed with SLE (included 35 pregnant women control group and48 women (study group) but only 28 women succeeded to get pregnancy and reach delivery phase) were recruited for conducting this study. Six tools were used for data collection named Arabic structured interviewing questionnaire, follow up diary, pregnancy health record, lupus Activity Index- Pregnancy (LAI-P), modified WHO partogram and Apgar score. Results: showed that there is a high statistical significant improvement in women's knowledge regarding SLE and statistical significant improvement on adherence to lupus medication administration after implementation of guideline. Moreover, there is a statistical significant decrease in degree of generalize pain and a highly statistically significant decrease in the mean score of SLEDAI after implementation of guideline. Pregnancy outcome revealed that maternal complications for control group were abortion, pre-eclampsia, PROM and gestational diabetes that represent 34.8, 13.1, 21.7 and 8.7% respectively. While, pre-eclampsia, PROM and gestational diabetes were maternal complications in the study group that represent 3.6%, 7.2% and 3.6% respectively. Concerning fetal outcome there was improvement in fetal outcome in the intervention group compared to control group. In addition 82.1% of the intervention group versus 22.7% of control group had a full term neonate. Concerning birth weight 71.4 % of the intervention group compared to 13.6% of the control group had neonate with normal birth weight. Conclusion: The implementation of preconception evidence based nursing guideline has a statistically significant positive effect on improving pregnancy outcome for women with SLE. Recommendations: Application of preconception evidence based nursing guideline for SLE women who planned to pregnancy at rheumatology, immunology clinics at Ain Shams University Hospitals.