Published: 2022-09-17

Retrospective study on maternal outcome in referred obstetric patients in government Doon medical college

Monica Chauhan, Roopal ., Neetu Kochhar


Background: The referral system forms an integral component of any health care system, for providing essential obstetric care to women during pregnancy and childbirth. The study was conducted with an objective to identify the pattern of obstetric referrals to Doon female hospital, government Doon medical college, primary reason for referral, delay in referral, clinical course, mode of management and outcome.

Methods: It is a retrospective observational study. All the referred obstetric cases were analyzed for the cause of referral, place of referral and outcome for the period of 6 months from October 2021 to march 2022.

Results: In our study we found total 486 obstetric patients were referred. Maximum referred patients were in the age group of 20-30 years and 61% referrals were from Dehradun district 12.96% of cases were delayed referrals.

Conclusions: Our study revealed that illiteracy and ignorance is the major factor that contributes to poor pregnancy outcome. Need of the hour is to train health care workers at primary and secondary health care center in essential and emergency obstetric care so as to avoid unnecessary referrals and reduce burden on tertiary health care hospitals and decrease in the frequency of delayed referrals so as to improve the maternal and fetal outcome.


Referred patients, Illiteracy, Health care workers

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Devineni K, Sodumu N. A study of spectrum of referral pattern at a tertiary teaching hospital towards better obstetric case. IAIM. 2016;3(8):193-8.

Shilpa SB, Anand PK. Study of obstetric referrals to teaching institute. Indian J Appl Res. 2013;3(7):469-71.

National Family Health Survey (NFHS-2) 1998-99. Bombay: International Institute of Population Services. 2000;196:247-51.

National Family Health Survey (NFHS-3) 2005-2006. Bombay: International Institute of Population Services. 2006;196:247-51.

Gupta PR, Chaudhari SN, Gonnade NV. Maternal and fetal outcome in referred patients to tertiary care center. Sch J App Med Sci. 2016;4(5C):1624-31.

Sabale U, Patankar MA. Study of maternal and perinatal outcome in referred obstetrics cases. J Evol Med Dent Sci. 2015;44448-55.

Patel RV, Pandya VM, Patel DB, Shah HD. Multiparametric study of obstetric and gynaecological emergency cases referred to a tertiary care centre. Indian J Med Res Pharm Sci. 2015;2:14-20.

Jakhar R, Choudhary A. Study of maternal outcome in referral obstetric cases in a tertiary care centre. J Family Med Prim Care. 2019;8(9):2814-9.

Devineni K, Sodumu N. A study of spectrum of referral pattern at a tertiary teaching hospital towards better obstetric care. IAIM. 2016;3:193-8.

Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH, Haddad SM, Costa ML et al. Brazilian Network for the Surveillance of Severe Maternal Morbidity study group. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC Pregnancy Childbirth. 2014;14:159.

Morse ML, Fonseca SC, Gottgtroy CL, Waldmann CS, Gueller E. Severe maternal morbidity and near misses in a regional reference hospital. Rev Bras Epidemiol. 2011;14:310-22.

Rööst M, Altamirano VC, Liljestrand J, Essén B. Does antenatal care facilitate utilization of emergency obstetric care? A case-referent study of near-miss morbidity in Bolivia. Acta Obstet Gynecol Scand. 2010;89:335-42.

Victora CG, Matijasevich A, Silveira M, Santos I, Barros AJ, Barros FC. Socio-economic and ethnic group inequities in antenatal care quality in the public and private sector in Brazil. Health Policy Plan. 2010;25:253-61.

Souza JP, Cecatti JG, Parpinelli MA, Krupa F, Osis MJ. An emerging “maternal near-miss syndrome”: narratives of women who almost died during pregnancy and childbirth. Birth. 2009;36:149-58.

Filippi V, Ronsmans C, Gohou V, Goufodji S, Lardi M, Sahel A et al. Maternity wards or emergency obstetric rooms? Incidence of near-miss events in African hospitals. Acta Obstet Gynecol Scand. 2005;84:11-6.

Lori JR, Starke AE. A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery. 2011;28:67-72.

Ganatra BR, Coyaji KJ, Rao VN. Too far, too little, too late: a community-based case–control study of maternal mortality in rural west Maharashtra, India. Bull World Health Organ. 1998;76:591-8.

Murray SF, Pearson SC. Maternity referral systems in developing countries: current knowledge and future research needs. Soc Sci Med. 2006;62:2205-15.