Publication:

Pathways of care for the obstetric cases referred to a tertiary care centre in North-East India: a prospective analysis

Background The referral system is crucial in emergency obstetric situations thereby reducing maternal morbidity and mortality along with improving neonatal outcomes. We aim to study the baseline characteristics of referred obstetric patients, analyse the reason for referral and determine the feto-maternal outcome of the referred patients.

Methods This was a prospective observational study conducted in a tertiary referral centre in Shillong, Meghalaya. Categorical variables were presented as frequency and percentages. Continuous variables presented as mean (SD). The predictors of adverse outcomes determined using chi square test. A p-value<0.05 was considered statistically significant.

Results The total number of referred cases in the study period was 500. The majority 300 (61%) from the age group <30 years and multi-gravida 59%. The majority 282 (57%) referring centres were within the radius of 20 km from the tertiary health care institute. The commonest indication of referral was Labour abnormalities 47 (9%). The maternal outcomes accounts for 454 (90.8%) went for discharges, 38 (7.6 %) were shifted to ICU, 7 (1.4%) cases expired and 1 went for LAMA. Perinatal outcomes, 70.9% were Live Birth, 7.5% were shifted to the NICU, 7.5% were pre-term, 7.4% were stillbirth, and 6.7% were abortion cases.

Conclusions In order to create an efficient referral system, the peripheral health care system must be strengthened with adequate, competent individuals and a robust referral mechanism in place. Prompt referrals accompanied with thorough and detailed referral slips may be helpful in facilitating early action.