A study of spectrum of referral pattern at a tertiary teaching hospital towards better obstetric care

Background: 22% of the population are constituted by women of child bearing age of 15-45 years in India. They are a vulnerable risk group which is due to pregnancy and child bearing. For providing access to essential obstetric care, the referral system is an essential component of any health systems which are important in pregnancy and child birth. Aim: This study was done to review the pattern of obstetric cases referred and to identify the clinical course, mode of management, maternal and perinatal outcomes. Materials and methods: This prospective observational study reviewed 100 obstetric cases. Thorough history was taken; complete physical and obstetric examination and relevant investigations were done. Management of the patient, clinical course, mode of delivery, both maternal and perinatal outcomes were documented. Results: Most common diagnosis at referral was medical disorders complicating pregnancy (45%) among which hypertensive disorders accounted for 34%, followed by severe anemia (17%). Twenty-one percent of the patients were in serious or critical condition on arrival, 29% patients required surgical intervention, 19% received intensive care management and there were no mortalities. Total number of live births were 73 (78.5%) among which 28 (30%) required neonatal admission and 5 (5.3%) had early neonatal death. Vaginal delivery rate was 78% in spite of high risk conditions and various complications. Only 30% had the required three visits and 18% had a delay ranging from 3hrs to 18 hours to reach the referral centre. Conclusion: Most common diagnosis at the time of referral was hypertensive disorders of pregnancy and its various presentations like eclampsia, HELLP, DIC, Abruption. There is still scope for improving antenatal care, reduce 1st delay, 2nd delay and need to strengthen FRU and emergency obstetric care centres at some of the districts.