Referrals revisited: a clinical audit
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20175036Keywords:
Barrier in referral service, High risk pregnancy, Obstetric referral, Referral protocolAbstract
Background: Pregnancy and childbirth are physiological processes; however, severe maternal morbidity can complicate certain pregnancies, deliveries and puerperium. To prevent maternal/ neonatal morbidity and mortality, the high-risk category needs timely identification and intervention and if required, prompt referral to higher centres where HDU/ICU level of care is provided. The present study was a clinical audit of obstetric referrals.
Methods: A clinical audit of all obstetrics referrals done at BJRM (secondary level facility) from 1st May to 31st October 2016. The cases were analysed with respect to demographics, indications for referral and barrier to services.
Results: Referral rate of our hospital was 6.52%. Mean age of women referred was 24.16 years. The associated risk factors were PIH in 36.17%, anaemia in 34.04%, followed by thrombocytopenia and diabetes in pregnancy. Majority of referrals were done in women during labour 93.94% while only 3.03% referrals during post-partum period. Most common indication was MSL with foetal distress 20.96%, followed by hypertensive disorders in pregnancy 16.93%. Other indications were APH, malpresentation, 2nd stage arrest and cord prolapse. The main barriers to providing services at our institute were unavailability of 24 hours OT services, blood bank and ICU care.
Conclusions: Standard referral protocol and well-defined linkages need to be established so as to have better co-ordination between the referral units and tertiary centres.
References
Bharti, Vijay K, Amandeep K, Sumit C, Manisha M. Prevalence and correlates of high risk pregnancy in rural Haryana: a community based study. Int J Basic Applied Med Sci. 2013;3(2):212-7.
World Health Organization. Global health observatory data (GHO) data. 2017. Available at http://www.who.int/gho/maternal_health/en/
Unicef India. What we do- maternal health, 2017. Available at http://unicef.in/Whatwedo/1/Maternal-Health
World Health Organization. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. 2014 Available at: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf
Siraj S, Bawar S. An audit of obstetrical referrals from district level hospitals to tertiary level hospitals of KPK. J Postgrad Med Inst. 2016;30(2):160-4.
Patel HC, Singh BB, Moitra M, Kantharia SL. Obstetric referrals: scenario at a primary health centre in Gujarat. Natl J Comm Med. 2012;3(4):711-4.
Bhopal SS, Halpin SJ, Gerein N. Emergency obstetric referral in rural Sierra Leone: what can motorbike ambulances contribute? a mixed-methods study. Matern Child Health J. 2013;17:1038-43.
Khatoon A, Hasny SF, Irshad S, Ansari J. An audit of obstetrics referrals to Abbasi Shaheed Hospital. Pak J Surg. 2011;27(4):304-8.
Qureshi RN, Sikandar R, Hoodbhoy Z, Bano R, Jabeen N. Referral pattern of emergencies in obstetrics: implications for defining scope of services and policy. J Pak Med Assoc. 2016;66(12):1606-10.
Sarika C, Bharat R, Vishal D, Ayesha DC. Quality of obstetric referral services in India’s JSY cash transfer programme for institutional births: a study from Madhya Pradesh province. J PLoS One. 2014;9(5):e96773
Maskey S. Obstetric Referrals to a Tertiary Teaching Hospital of Nepal. NJOG. 2015;19(1):52-6.