Obstetric Referrals to a Tertiary Hospital in Northern Uganda - A One Year Experience

Abstract

BACKGROUND Delay in referral adversely affects maternal and neonatal outcome. We wanted to review the obstetric referrals, source of referrals, appropriateness of referrals and document the maternal and perinatal outcomes in a tertiary hospital in northern Uganda. METHODS This is a secondary data analysis from case records. A descriptive study of 780 eligible obstetric referrals, with ≥28 week’s gestation, referred to the hospital for a period of 12 months were analysed with SPSS version 23. RESULTS Obstetric referrals accounted for 16.3% (780/4799) of the total admissions in 2018, 43.8% were from CEMNOC sites and 32.3% from HC IVs, while 57% from without Lira District, showing lacunae in the emergency obstetric care given at the HC IV levels and the districts hospital in the region. Majority or 93.5% (729) were intrapartum admissions and 98.1% (715) of these had labour outcome recorded, showing the nature of referrals. Most common diagnosis at referral was labour or complications of labour and only 4.6% had other diagnoses. The diagnoses at the time of admission were normal labour (31.0%); obstructed labour (25.1%); prolonged labour (7.1%). About 29.9% presented with more than one medical/obstetric complications, and the most common one was obstructed labour, preeclampsia, IUFD and previous caesarean section scars. The outcome of the referred cases included 45.1% (327) vaginal delivery (either spontaneous or augmented), 54.4% (396) caesarean section, 0.5% (4) Caesarean hysterectomy, 3.1% (24) transferred out undelivered, 1.2% (09) missing outcome while the 3.6% (28) with medical conditions were managed and discharged. There were ten (10) maternal deaths among the referrals, during the study period and 3 were due to obstetric haemorrhage; and behind these there were many near misses which would provide valuable information on the quality of care at the peripheral facilities. 80.4% (627) were live babies, 10.5% (82) were FSB/MSB and 10% had APGAR score ≤5 at 5 minutes of birth while 13.2% were of low birth weight. CONCLUSIONS A wide spectrum of complicated and uncomplicated obstetric cases was referred to this hospital and majority were unjustifiable as majority of the referred conditions could be managed at the lower CEMONC sites. Unavailability of Comprehensive Emergency Obstetric Care (CEMONC) was the most common reason for referrals, even where infrastructure and human resource where known to be available. Most common diagnosis at the time of referral was prolonged/obstructed labour. Even today, obstetric haemorrhage is the leading cause of maternal mortality while prolonged/obstructed labour contributed to the high neonatal mortality. KEY WORDS Obstetric Referrals, Maternal, Outcome, Foetal Outcome, Referral Sites, Tertiary