PROMPT REFERRAL PRACTICES AS A STRATEGY FOR THE MANAGEMENT OF OBSTETRIC EMERGENCIES

Background: Obstetric emergencies, including postpartum haemorrhage, severe pre-eclampsia and eclampsia, obstructed labour, puerperal sepsis and complications of unsafe abortion, remain the leading direct causes of maternal and perinatal mortality in sub-Saharan Africa. Prompt referral from community and primary-care levels to facilities providing emergency obstetric care is a critical, yet persistently weak, link in the continuum of maternity care. Objective: To systematically identify and synthesise the available evidence on prompt referral practices used as a strategy for the management of obstetric emergencies in sub-Saharan Africa, and to characterise the referral models, communication modalities, pre-referral care content, outcomes and implementation barriers reported. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported per the PRISMA-ScR checklist. PubMed/MEDLINE, CINAHL, Scopus, African Index Medicus and grey-literature sources were searched for records published between January 2015 and March 2025. Two reviewers independently screened titles, abstracts and full texts against pre-specified eligibility criteria. Results: Sixty-two records met the inclusion criteria. Six themes emerged: (i) community-to-facility referrals by traditional birth attendants and community health workers; (ii) facility-to-facility referrals from primary to secondary or tertiary care; (iii) pre-referral communication and mHealth-enabled triggers; (iv) referral-form completeness and the content of pre-referral care (magnesium sulphate, anticonvulsants, intravenous fluids); (v) maternal and perinatal death surveillance and response as a referral audit mechanism; and (vi) cross-cutting themes of equity, ambulance systems, cost and implementation. Reported referral completion rates ranged from 43 to 81 percent, with mean transfer times of 65 to 180 minutes. Conclusion: Prompt referral practices for obstetric emergencies in sub-Saharan Africa remain sub-optimal and inequitably distributed. Strengthening nursing-led referral protocols, ambulance and communication systems, and maternal death surveillance and response offers a tractable pathway to reducing preventable maternal mortality.