Publication:

Fetomaternal outcome of referred obstetrics patients in tertiary care centre

Background Pregnancy is a natural physiological process, with most cases being low-risk and managed safely at primary healthcare centers. However, the timely referral of high-risk pregnancies to specialized care is crucial to prevent complications and reduce maternal and neonatal morbidity and mortality. In India, particularly in rural areas, the referral system’s efficiency is vital in improving feto-maternal outcomes. Despite improvements in maternal mortality rates, the referral system faces challenges, such as poor coordination and delayed referrals, undermining further reductions in maternal mortality. This study examined the outcomes of emergency obstetric transfers to a tertiary hospital, focusing on the reasons for these transfers and the impact of specialized care on maternal and neonatal health.

Methods A retrospective observational study was conducted at GSVM Medical College, Kanpur, over a six-month period from January 1, 2024, to June 31, 2024. Data were collected on maternal and fetal demographic characteristics, clinical and obstetric conditions, and neonatal outcomes from hospital records. The study population included all obstetric cases >28 weeks referred to the department of obstetrics and gynecology.

Results Out of 2459 deliveries, 718 cases (29.2%) were referred, with the majority (78.6%) in the 21-30 age group. Most referrals were multipara (54.4%) and from district hospitals (43.8%) and CHCs (41.4%). The main reasons for referral were pre-eclampsia (13.6%), previous caesarean sections (11.4%), and anemia (12.4%). Maternal morbidity was observed in 244 cases (34%), with anemia, postpartum hemorrhage, and eclampsia being the most common complications. Maternal mortality occurred in 12 cases, primarily due to hypertensive disorders, coagulopathy, and sepsis. Among 735 births, 81.2% of babies were discharged without complications, 14.5% required NICU admission, and 4.3% were stillborn.

Conclusions Timely referral and specialized care are critical in managing high-risk pregnancies and improving maternal and neonatal outcomes. Strengthening first referral units (FRUs) and training healthcare workers are essential steps to enhance the referral system and reduce the burden on tertiary care facilities.