STUDY OF OBSTETRIC REFERRAL PATTERNS IN A TERTIARY LEVEL HOSPITAL
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Keywords
Obstetric Referral, Maternal Outcome, Perinatal Mortality, Emergency Obstetric Care, Cesarean Delivery.
Abstract
Background: Maternal and perinatal outcomes depend heavily on timely access to quality obstetric care. Referral of obstetric cases is crucial in managing high-risk pregnancies and complications, particularly in resource-limited peripheral centers. This study aimed to analyze referral patterns, reasons for referrals, and associated maternal and perinatal outcomes at Lady Goschen and KMC Attavar Hospitals.
Methods: A prospective cross-sectional study was conducted over two years (September 2019–August 2021) at Lady Goschen and KMC Attavar Hospitals. All unregistered obstetric cases referred with a valid referral letter were included. Data were collected regarding demographic profiles, reasons for referral, associated risk factors, mode of delivery, and maternal and perinatal outcomes. Statistical analysis was performed using SPSS version 23.
Results: A total of 735 referred cases were analyzed. In Lady Goschen Hospital, 59% were multigravidae, whereas 54.2% in Attavar were primigravidae. Women above 30 years constituted 54.7% in Lady Goschen, while 62.5% of referrals at Attavar were under 30 years. The most common reasons for referral were non-availability of skilled doctors (41.4% at LGH; 41.7% at Attavar) and lack of facilities such as NICU or OT (39.7% at LGH; 40% at Attavar). Gestational hypertension (4.8%) and gestational diabetes mellitus (2.4%) were the commonest risk factors at LGH, while both were 12.5% at Attavar. Most patients underwent cesarean delivery (41% at LGH; 45.8% at Attavar). Intrauterine deaths were reported in 10.5% at LGH and 12.5% at Attavar, with maternal mortality of 0.3% in LGH and none in Attavar. Conclusion: Referral systems play a pivotal role in reducing maternal and perinatal mortality. The majority of referrals were due to inadequate availability of skilled doctors and essential facilities. Strengthening emergency obstetric care services, training healthcare personnel, and improving infrastructure are essential to enhance outcomes.
References
[2] India Birth rate, 1950-2020 - knoema.com https://knoema.com › atlas › India › Birth-rate
[3] Maternal Mortality Rate (MMR) - PIB https://www.pib.gov.in › Press Release Page
[4] https://main.mohfw.gov.in/sites/default/files/Healthand Family Wel farestatisticsinIndia 201920.pdf
[5] Basic Emergency Obstetric Care A Trainer's Guide - JICA
[6] Kyei-Onanjiri M, Carolan-Olah M, Awoonor-Williams JK, et al. Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey. BMC Health Services Research 2018;18(1):184.
[7] Gupta PR, Chaudhari SN, Gonnade NV. Maternal and fetal outcome in referred patients to tertiary care center. Sch J App Med Sci 2016;4(5C):16.
[8] Goswami P, Bindal J, Chug N. To study pattern of obstetric cases referred at tertiary care centre in central India. Int J Reprod Contracept Obstet Gynecol 2017;6:2370-4.
[9] Jyotsana, Kapadia LD, Vohra H. Study of maternal and perinatal outcome of referred patients in tertiary health centre. Int J Reprod Contracept Obstet Gynecol 2017;6:5363-7.
[10] Panchal V, Patel S. Study of maternal and fetal outcome of patients referred in third trimester of pregnancy at tertiary care hospital. Sch J App Sci 2015;3:2449-52.
[11] Devineni K, Sodumu N. A study of spectrum of referral pattern at a tertiary teaching hospital towards better obstetric care. IAIM 2016;3(8):193-8.
[12] Latika, Nanda S, Sirohiwal D, et al. To study the pattern of maternal and perinatal outcome of referred obstetrics cases in a tertiary care hospital of Northern India. Int J Clin Obstet Gynaecol 2020;4(5):216-9.
[13] Jakhar R, Choudhary A. Study of maternal outcome in referral obstetric cases in a tertiary care centre. J Family Med Prim Care 2019;8:2814-9.
[14] Morsheda B, Shamsun N, Hashima EN; Assessing the MANOSHI Referral System Addressing Delays in Seeking Emergency Obstetric Care in Dhaka’s Slums. MANOSHI Working Paper Series No. 10.2010; Manoshi-WP10:1- 36 published by ICDDR,B, BRAC.
[15] Jha N, Dutta I, Gopal N. A Study on Maternal and Perinatal Outcome in Referred Obstetric Cases of Gestational Age More Than 28 Weeks in a Rural Medical College Hospital. J South Asian Feder Obst Gynae 2018;10(Suppl 1):302-9.
[16] Rathi C, Gajria K, Soni N. Review of referred obstetric cases – maternal and perinatal outcome. Bombay Hosp J 2010;52(1):52-6.
[17] Sabale U, Patankar AM. Study of maternal and perinatal outcome in referred obstetrics cases. Journal of Evolution of Medical and Dental Sciences 2015;4(26):4448-55.
[18] Geleto A, Chojenta C, Musa A, et al. Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature. Syst Rev 2018;7:183.
[19] Dutta I, Roy P, Dasgupta S, et al. Obstetrics referrals: Maternal and perinatal outcome in medical college hospital in eastern India. Indian J Obstet Gynecol Res 2020;7(1):91-9.
[20] Poornima M, Daver RG. Maternal and fetal outcome in obstetric referred cases. Glob J Res Analys 2018;7(2):544-7.
[21] Mahendra G, Kavya BS, Pukale RS. Study of maternal and perinatal outcome in referred obstetric cases. Obs Rev: J Obstet Gynecol 2019;5(2):106-11.
[22] Goswami D, Makhija A. A study of high risk obstretic referrals to tertiary care hospital in Garhwal, Uttarakhand. IJSR 2015;4(10):1091-3.
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Dr. Prutha B
*Junior Resident, Department of Obstetrics and Gynaecology, Kasturba Medical College, Mangalore, Karnataka, India.
Dr. Vijaya M. Revankar
Professor, Department of Obstetrics and Gynaecology , Kasturba Medical College, Mangalore, Karnataka, India.