Analysis of referred cases in a tertiary care center in Mysuru, Karnataka

Background: Pregnant women are at high risk for life threatening complications throughout the pregnancy and during delivery. Early detection of complications and prompt referral to higher level of care can reduce associated adverse maternal outcome. Improvement in quality of maternal child health care at primary health centre, community health centre level, regular training of healthcare provider in emergency obstetrics care is required to curb unnecessary referrals and consequently reducing feto maternal morbidity and mortality. Methods: This is a observational study conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached to MMCRI mysuru. Patients are referred from nearby primary health centre, community health centre, district hospital and private hospitals. All referred antenatal and intra- natal patients to our center of>24 weeks of gestational age were studied. Results: During this study period of 1 year, there were about 9234 admissions of obstetric cases out of which 6535 (70.7%) were referred cases. Maximum cases i.e.,4300 (65%) were in the age group of 20-30years age group. The most common indication for referral was PIH-2091 (32%), preterm labour (Lack of NICU facility)-1110 (17%), followed by fetal distress-718 (11%), lack of maternal ICU facility-8%, lack of cardiologists-4%. Out of the total referred cases, 2287 (35%) delivered vaginally, 3332 (51%) delivered by lower segment caesarean delivery but the remaining 916 obstetric cases did not have the follow up. Maternal morbidity was seen in 2854 (43%) of which requiring ICU admissions in 12%, PPH seen in 7%, requiring dialysis in 3%, puerperal sepsis in 1.8% , wound gaping in 2.1%, Total maternal death were-4.78% neonates were shifted to mother side, whereas 18% were admitted to NICU. Conclusions: Referral helps healthcare seekers to reach a high level of care in the health system in a span of time. Identification of high risk factors by health personnel and timely decisions about intervention is important. Present study showed that timely referral is crucial for a satisfactory maternal and fetal outcome. In order to reduce unnecessary referral and burden on tertiary care hospitals, strengthening of existing first referral units (FRU) is necessary to provide better services and will help in achieving goal of ideal maternal mortality rate and neonatal mortality rate.