Published: 2017-10-28

Referrals revisited: a clinical audit

Swati Dubey, Sumita Mehta, Sonam Singh, Anshul Rohatgi


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.


Barrier in referral service, High risk pregnancy, Obstetric referral, Referral protocol

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