DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203315

Emergency obstetric care among referrals in more than 24 weeks gestation at a tertiary care teaching institution in Kerala, India

Heera Shenoy T., Sheela Shenoy T., Remash K., Sony Simon

Abstract


Background: One of the biggest barriers confronting efforts to reduce maternal mortality through increased skilled delivery is access to emergency obstetric care. This study aimed to look into the profile of emergency obstetric referrals. Referral-decision interval, reasons and morbidities of referral were analysed and their neonatal outcomes assessed.

Methods: This observational study reviewed 90 emergency obstetric referrals over 3 years from June 2013 to February 2016.

Results: In-labour referrals constituted the majority of emergency obstetric referrals. Preterm obstetric referrals needed emergency interventions in view of medical/obstetric indications and it was statistically significant. Referral- decision and referral-arrival interval was significant in emergency group (p-value-0.001). Babies born to mothers who were obstetric emergency referrals had extended NICU stay (p-value-0.001). There was a maternal death and four near-misses in this research.

Conclusions: Timely decisions taken during interhospital emergency referrals resulted in better perinatal outcomes by prompt maternal interventions.


Keywords


Emergency, Foetal, Maternal, Morbidity, Obstetric, Perinatal, Referrals

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References


Park K. Textbook of Preventive and Social Medicine 17th ed. Jabalpur. Banarasidas Bhanoj Publishers; 2000: 632.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091-1110.

Brun JL, Billeaud C, Elleau C, Guyon F, Roux D, Dallay D, et al. Maternal transport to the Bordeaux University Hospital: a retrospective study of 263 cases (1996-1998). J Gynecol Obstet Biol Reprod. 2000;29(4):414-22.

Swain S, Prakash A. Utilisation of referral services by high risk pregnant population in rural Varanasi. Indian J Matern Child Health. 1992;3(3):74-6.

Koblinsky M, Chowdhury ME, Moran AC, Ronsmans C. Maternal morbidity and disability and their consequences: neglected agenda in maternal health. J Health Popul Nutr. 2012;30:124-30.

Lee AC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA, et al. Linking families and facilities for care at birth: what works to avert intrapartum related deaths? Int J Gynecol Obstet. 2009;107(1):65-8.

World Health Organisation, UNICEF, UNFPA, World Bank, UN Population Division. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division. Geneva: World Health Organisation; 2014.

Shailja S, Singh M. National health policy 2017: Can it lead to achievement of sustainable development goals? Available at: https://www.researchgate.net/profile/Mitasha_Singh/publication/322287585_National_health_policy_2017_Can_it_lead_to_achievement_of_sustainable_development_goals/links/5a505 0140f7e9bbc10538ef7/National-health-policy-2017Can-it-lead-to-achievement-of-sustainabledevelopment-goals.pdf. Accessed on 27 November 2018.

Chandramouli C. Census of India 2011: Provisional population totals: Paper 1 of 2011. India: Series 1. New Delhi: Office of the Registrar General and Census Commissioner, India; 2011.

Akbari A, Mayhew A, Al-Alawi MA, Grimshaw J, Winkens R, Glidewell E, et al., authors. Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev. 2008;4:CD005471.

Chaturvedi S, Randive B, Diwan V, De Costa A. Quality of obstetric referral services in india’s jsy cash transfer programme for institutional births: a study from Madhya Pradesh Province. PLoS ONE. 2014;9(5):e96773.

Morsheda B, Shamsun N, Hashima EN. Assessing the MANOSHI referral system addressing delays in seeking emergency obstetric care in Dhaka’s Slums. MANOSHI working paper series Manoshi-WP10:1-36 published by ICDDR, B, BRAC. 2010;10.

Ohn HT, Patrick DC, Zaw W, Mary K, Hnin YK, Herni B. Inter-hospital emergency obstetric referrals to the labour ward of RIPAS Hospital Brunei Int Med J. 2011;7(1):22-33.

Sheikh A, Dunphy J, Humphries C, MacArthur C, Manaseki-Holland S. Maternity handover in Kerala: a cross sectional study. Int J Community Med Public Health. 2018;5:3760-6.

Sodani PR, Sharma K. Training needs Assessment of Public Health Programmes in Maternal and Neonatal Care. Indian J Maternal Child Health. 2011;13(4):1-8.

Alehagen SA, Finnstrom O, Hermansson GV, Somasundaram KV, Bangal VB, Patil A, et al Nurse-based antenatal and child health care in rural India, implementation and effects: an Indian-Swedish collaboration. Rural Remote Health. 2012;12(3):2140.

Patel HC, Singh BB, Moitra M, Kantharia SL. Obstetric referrals: scenario at a primary health centre in Gujarat. Natl J Community Med. 2012;3:711-4.

Pembe AB, Carlstedt A, Urassa D, Lindmark G, Nyström L, Darj E. Effectiveness of maternal referral system in a rural setting: a case study from Rufiji district, Tanzania. BMC Health Serv Res. 2010;10:326.

Jahn A, De Brouwere V. Referral in pregnancy and childbirth: Concepts and strategies. In: Press I, editor. De Brouwere V, Van Lerberghe W. Safe motherhood strategies: a review of the evidence. Antwerp; 2001.

Agarwal N, Singla R, Dhaliwal L, Suri V. Audit of emergency obstetric referrals - a pilot study from tertiary care centre of North India Bangladesh J Obstet Gynaecol. 2015;30:25-2.

Hitesh J. Perceptions and constraints of pregnancy related referrals in rural Rajasthan. J Family Welfare. 1996;42(1):24-9.

Kaul V, Bagga R, Jain V, Gopalan S. The impact of primary postpartum hemorrhage in "near-miss" morbidity and mortality in a tertiary care hospital in North India. Indian J Med Sci. 2006;60(6):233-40.

Narsaria K, Mukhopadhaya P, Kyal A, Agarwal K, Agarwal A, Sanghi S. Study of obstetric referrals -one year experience at a tertiary care centre in West Bengal HECS. Int J Com Health Med Res. 2017;3(3):32-6.

Rathi C, Gajria K, Soni N. Review of referred obstetric cases-Maternal and perinatal outcome. Bombay Hospital J. 2010:52:52-6.

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