Obstetric referrals to a tertiary care maternity: a descriptive study

Abstract

IntroductionAn effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines.MethodsA descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals.ResultsReferrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital.ConclusionThe current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.

Outcomes of Pregnancy-Related Referrals From Rural Health Facilities to Two Central Hospitals in Harare, Zimbabwe: A Prospective Descriptive Study

“…The proportion of stillbirths in this study was high (10.7%) when compared to ndings from a Tunisian study (1.8%) [33] but lower when compared to a similar study in Nigeria (16.4%) [36]. This is a re ection of the deteriorated healthcare services in Zimbabwe and other sub-Saharan countries which persistently reported stagnant coverage levels of effective interventions recommended for maternal, neonatal, and child health [37].…”

“…There were nine maternal deaths (CFR = 4.4%) during the three months of the study period and this frequency was very high when compared to other studies which reported no deaths over three months [33] and 13 deaths over four years [38]. UNICEF/WHO/UNFPA recommend a maximum acceptable CFR of less than 1% [57].…”

“…The literature review showed varying rates and reasons for referral of obstetrics patients from peripheral to tertiary health facilities [31,32]. This was mainly due to the different clinical criteria used for transferring and admitting patients, as well as distance traveled [33]. It was noted that the majority of participants in this study delivered by cesarean section at the two central hospitals despite having provincial and district hospitals which are supposed to be equipped to carry out the procedure, an observation that was also made by Ghardallou and colleagues in Tunisia.…”

Fetomaternal Outcome in Referral Obstetric Patients in Tertiary Care Hospital

“…In this study, there were 7,751 total deliveries, out of which 2,233 (28.8%) cases were referred, which is comparatively more than studies done by Jakhar and Choudhary 6 (9.96%), Ghardallou et al 7 (15.23%), and Shenoy et al 8 (7.03%). Fetomaternal Outcome in Referral Obstetric Patients…”

“…One thousand eight hundred thirty-two (80.8%) babies shifted to mother without any complication, 325 (14.3%) required NICU admission, and 110 (4.9%) had stillbirth. Ghardallou et al 7 reported (98.2%) live birth, (1.8%) stillbirth, and (9.3%) NICU admission. Akaba and Ekele 14 reported (16.4%) stillbirth.…”