Citation Information :
Nekkanti LP. A Study of Obstetric Referral Cases to Tertiary Care Center in Rural Setting of Mahasamund, Chhattisgarh. J South Asian Feder Obs Gynae 2024; 16 (4):359-364.
Background: An effective referral system is key to access timely emergency obstetric care in order to prevent maternal and perinatal mortality. The criticality of referrals makes it necessary to understand its pattern at the health system level. This study was conducted with an objective to document the patterns, primary reasons of obstetric case referral and the maternal and perinatal outcome of the referred cases in Government Medical College, Mahasamund in rural Chhattisgarh. As a systematic monitoring of referrals majorly helps to identify current gaps and timeliness of referral in providing essential obstetric care.
Methods: The study is based on the health records and details on referral forms from referral center and peripheral health facilities. This follow-up study was conducted in between July 2022 and June 2023 (12 months). All referred patients for obstetrics indications above 20 weeks and patients with postpartum indications were included. Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes.
Results: According to our study, out of a total of 5,962 delivered patients, 1,281 (20.5%) cases were referred patients. Maximum cases, i.e., 567 (44.2%) were in the age-group of 24–29 years. The major reasons for referring patient were hypertensive disorders of pregnancy (11.2%), previous cesarean section (9.8%), and PPH (9.5%). There were six maternal deaths (0.5%) and discharge rate was 96.2%.
Conclusion: The present study showed that illiteracy and ignorance of female regarding healthcare requirements and poor infrastructure came out to be a major contributor of poor pregnancy outcome. Timely referral is crucial for a satisfactory maternal and fetal outcome. To reduce the number of unnecessary referrals and to reduce burden on tertiary care hospitals, healthcare workers should be trained in essential and emergency obstetric care which will help in reducing morbidity and mortality.
World Health Organization: ICD-10: International statistical classification of diseases and health-related problems. In Tenth Revision. Geneva: World Health Organization; 1993, p. 2. Available from: https://icd.who.int/browse10/Content/statichtml/ICD10Volume2_en_2010.pdf.
Rathi C, Gajria K, Soni N. Review of referred obstetric cases – Maternal and Perinatal Outcome. Bombay Hosp J 2010;52(1):52–56. Available from: https://citeseerx.ist.psu.edu/document?repid=rep1& type=pdf&doi=34433d8d143828d3d952bc8d9f62e5ea3c2bd56e.
Ministry of Health and Family Welfare. Framework for Implementation of National Health Mission 20122017. Government of India. Available from: http://www. vikaspedia.in/health/nrhm/nationalhealthmission/nrhframeworkforimplementation. [Last accessed on 2016 Jun 01]. https://nhm.gov.in/New_Updates_2018/NHM/NHM_Framework_for_Implementation__08-01-2014_.pdf.
De Brouwere V, Derveeuw M, Van Damme W, et al. Safe motherhood. Lancet 1999;354(9195):2085. DOI: 10.1016/S0140-6736(05)76831-8.
Jakhar R, Choudhary A. Study of maternal outcome in referral obstetric cases in a tertiary care centre. J Family Med Prim Care 2019;8(9):2814–2819. DOI: 10.4103/jfmpc.jfmpc_402_19.
Kant S, Kaur R, Malhotra S, et al. Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India. J Family Med Prim Care 2018;7(1):137–141. DOI: 10.4103/jfmpc.jfmpc_348_17.
Devineni K, Sodumu N. A study of spectrum of referral pattern at a tertiary teaching hospital towards better obstetric case. IAIM. 2016;3(8):193–198. Available from: https://www.iaimjournal.com/wp-content/uploads/2016/08/iaim_2016_0308_27.pdf.
Thaker R, Deliwala K, Jadav MM. Retrospective comparative study of obstetric complications and maternal mortality in registered and unregistered women at tertiary care hospital. NHL J Med Sci 2013;2(1):28–35. DOI: 10.4103/jfmpc.jfmpc_402_19.
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(7A):2449–2452. DOI: 10.36347/sjams.2015.v03i 07.001.
Chauhan M, Roopal, Kochhar N. Retrospective study on maternal outcome in referred obstetric patients in government Doon medical college. Int J Reprod Contracept Obstet Gynecol 2022;11(10):2619–2624. DOI: https://doi.org/10.18203/2320-1770.ijrcog20222345.
Khatoon A, Hasny SF, Irshad S, et al. An audit of obstetrics referrals to Abbasi Shaheed hospital. Pak J Surg. 2011;27(4):304–308. Available from: https://www.pjs.com.pk/journal_pdfs/oct-dec11/p304.pdf.
Goswami D, Makhija A. A study of high-risk obstetric referrals to tertiary care hospital in Garhwal, Uttarakhand. Int J Sci Res 2013;4(9):4. Available from: https://www.ijsr.net/archive/v4i10/SUB158910.pdf.
Kumari A, Shaila M, Vani A. Spectrum of obstetric referral and their outcome at a Tertiary Care Center of Eastern Uttar Pradesh: An insight. Asian J Med Sci 2022;13(4)123–128. DOI: 10.3126/ajms.v13i4.43375.
Jahn A, De Brouwere V. Referral in pregnancy and childbirth: Concept and strategies. Stud Health Serv Organ Policy 2001;17:229–246. Available from: https://www.uonn.org/wp-content/uploads/2016/08/Referral-in-pregnancy-and-childbirth.pdf.
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):1624–1631. Available from: https://journals.indexcopernicus.com/api/file/viewByFileId/358613.
Sabale U, Patankar MA. Study of maternal and perinatal outcome in referred obstetrics cases. J Evol Med Dent Sci 2015;4448–4455. DOI: 10.14260/jemds/2015/643.
Patel RV, Pandya VM, Patel DB, et al. Multiparametric study of obstetric and gynaecological emergency cases referred to a tertiary care centre. Indian J Med Res Pharm Sci 2015;8(9):14–20. Available from: https://citeseerx.ist.psu.edu/document?repid=rep1&type= pdf&doi=252629423f4ebaa446363b7eda73368e59cc945f.
Sharma S. Evaluation of referred obstetric cases. A thesis submitted to the Devi Ahilya Vishwavidyalaya, Indore as partial fulfillment for the degree of M.S. (Obstetrics and Gynaecology) 2007.
Goswami P, Bindal J, Chug N. To study pattern of obstetric cases referred at tertiary care centre in Central India. Int J Reproduct Contracep Obstet Gynecol 2017;6(6):2370–2374. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20172315.
Kambo I, Bedi N, Dhilon BS, et al. A critical appraisal of caesarean section rates at teaching hospitals in India. Int J Gynecol Obstet 2002;79(2):151–158. DOI: 10.1016/s0020-7292(02)00226-6.
Shrivastava N, Shrivastava V. Study of maternal and perinatal outcome of referred patients in tertiary health centre. JEMDS 2014;3(35):9250–9256. DOI: 10.14260/jemds/2014/3194.
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):91–99. DOI: https://doi.org/10.18231/j.ijogr.2020.019.
Kaur D, Kaur V, Yuel VI. Alarmingly high maternal mortality in 21st century. J K Sci 2007;9(3):9. Available from: https://jkscience.org/archive/volume93/Original%20Article/ALARMINGLY%20HIGH%20MATERNA.pdf.
Ameyaw EK, Amoah RM, Njue C, et al. Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: A mixed-methods study. BMC Health Serv Res 2022;22:347. DOI: https://doi.org/10.1186/s12913-022-07760-6.
Azzolini E, Furia G, Cambieri A, et al. Quality improvement of medical records through internal auditing: A comparative analysis. J Prev Med Hyg 2019;60(3):250–255. DOI: https://doi.org/10.15167/2421-4248/jpmh2019.60.3.1203.
Furia G, Poscia A, Azzolini E, et al. The importance of clinical audit: A comparative analysis of quality of medical records: Giuseppe Furia. Eur J Public Health 2014;24(2):093–163. DOI: 10.1093/eurpub/cku163.093.