UTILIZATION AND OUTCOMES OF EMERGENCY OBSTETRIC CARE SERVICES IN A TERTIARY REFERRAL CENTRE: AN OBSERVATIONAL STUDY.

Abstract

Emergency obstetric care (EmOC) is central to maternal survival in developing nations where 99% of global maternal deaths occur. Despite India’s steady maternal mortality ratio (MMR) decline from 384 to 103 per 100,000 live births (2004–2019) through initiatives like Janani Suraksha Yojana and LaQshya, referral-related delays continue to burden tertiary centers. This study aimed to assess referral quality, timeliness of interventions, and maternal–perinatal outcomes among obstetric emergencies referred to a tertiary teaching hospital in Central India.

Methods:
A prospective observational study was conducted from January to December 2022 at a 1,500-bed tertiary hospital providing full EmOC services. Seventy consecutive women ≥20 weeks gestation referred with major obstetric emergencies (hypertensive disorders, hemorrhage, labor obstruction, uterine rupture, or abruption/accreta) were enrolled. Data included sociodemographic profile, referral logistics, intervention time intervals, and outcomes. Referral quality was assessed on a 10-point checklist. Statistical analysis used chi-square, t-test, and multivariate logistic regression to identify predictors of severe maternal outcome (SMO).

Results:
Among 70 cases, mean age was 26.4 ± 4.8 years; 54.3% were unbooked and 64.3% from rural areas. Referrals originated from PHCs (62.9%) and predominantly used private transport (57.1%). The mean delay was 5.8 ± 3.2 hours, with a median referral quality score of 3/10. Prolonged labor (31.4%) and preeclampsia/eclampsia (25.7%) were leading causes. Cesarean delivery was required in 64.3%, blood transfusion in 48.6%, and hysterectomy in 5.7%. The incidence of SMO was 32.9% (near-miss 28.6%, mortality 4.3%), with a mortality index of 13%. Perinatal mortality was 22.9% (stillbirth 14.3%, neonatal death 8.6%). Delayed referral (>6 hours) significantly increased SMO risk (OR 3.2, 95% CI 1.4–7.1, p = 0.004) and perinatal death (OR 2.8, p = 0.012).

Conclusion:
The study highlights critical EmOC referral gaps in Central India—poor documentation, inadequate stabilization, and transport delays—culminating in high near-miss and perinatal mortality rates. Strengthening first-referral units through standardized stabilization bundles, enforced ambulance use, and obstetric HDU expansion can curb preventable maternal deaths and accelerate progress toward SDG 3.1 targets.