Publication:

Overview of referred cases both referred in and referred out obstetric patients and outcome of referred out cases in tertiary hospital, Hassan Institute of Medical Sciences, Hassan

Background An effective obstetric referral system is essential for ensuring timely management of high-risk pregnancies and reducing maternal morbidity and mortality. Tertiary care centers play a crucial role in managing complicated obstetric cases referred from peripheral health facilities. This study aimed to evaluate the pattern of obstetric referrals, including both referred-in and referred-out cases, and to assess the outcomes of referred-out patients at a tertiary care hospital.

Methods A retrospective observational study was conducted at the Department of Obstetrics and Gynecology, Hassan Institute of Medical Sciences, Hassan. Data were collected from hospital records for the years 2021 and 2022. Information regarding total obstetric admissions, referred-in cases, causes of referral, monthly distribution of referrals, and outcomes of referred-out patients was analyzed using descriptive statistics.

Results A total of 6,344 obstetric admissions were recorded in 2021, with 2,171 (34.2%) referred cases, while in 2022 there were 6,210 admissions with 3,307 (53.3%) referred cases, indicating an increase in referrals. The most common indications for referral included hypertensive disorders of pregnancy, anemia, previous caesarean section, fetal distress, preterm labor requiring NICU care, and PROM. System-related factors such as unavailability of obstetricians and patient request also contributed to referrals. Most referred-out patients were discharged after treatment; however, a small proportion were lost to follow-up and a few maternal deaths were recorded.

Conclusions The study highlights a substantial proportion of obstetric referrals to tertiary care centers, mainly due to high-risk pregnancy complications and limitations in peripheral healthcare facilities. Strengthening antenatal care, improving infrastructure, and ensuring timely referral may help improve maternal outcomes.