Dr. Heera Shenoy T,
BACKGROUND Referral of high risk mother plays a pivotal role especially in developing country like India to reduce foetomaternal mortality. Timely and prompt obstetric referral is one of the effective strategies to avoid adverse pregnancy outcome. The objective of this study was to evaluate the obstetric referrals and their outcome in a tertiary care center in South Kerala. Aims and objectives of the study are- 1) To review the primary reasons for obstetric referral and place of referral. 2) To evaluate the maternal morbidity, neonatal course and care during NICU stay and perinatal outcomes MATERIALS AND METHODS Design- A retrospective study setting: Travancore Medical College Hospital, a tertiary health care facility in South Kerala. Subjects- 124 obstetrical referrals from nearby private and public health care settings over a period from June 2013 to February 2016. Study Variables- Age, demographic data on income, source of referral, distance from the referred centre, reasons for referral, co-morbidities, gestational age, parity, neonatal outcome. RESULTS 73.4% were in the age group 20 – 30 years with a mean age of 26 years. 82.3 % were in the rural set up. 48.3% were nullipara and 50% were multipara. Maternofoetal issues were the main reasons for obstetric referrals (58.1%). 103 referrals (83.1 %) were from Private sector. 64 were in-labour referrals. 48 Hours of delay was noted for emergency decision in 64.5% cases. 47.6% referrals were noted in the 33-36.6 weeks gestation. Previous caesarean in labour comprised 29 cases. Caesarean section was the mode of delivery in 83%. Anaemia was the most common medical disorder (34%) followed by hypertensive disorders of pregnancy (30.5%). Gestational diabetes mellitus was noted in 14.2% and hypothyroidism in 17.7%. There was 1 maternal death and 4 near miss mortality. 104 of 135 neonates were singletons and 31 (23%) were multiples. 96 neonates needed NICU admissions. 72% were preterm babies and 84% neonates survived. CONCLUSION Maternofoetal causes were the main reason for obstetric referrals. Maternal comorbidities like anaemia, hypertensive disorders, preterm labour, infections and foetal risk factors have to be diagnosed and referred at the earliest to a tertiary hospital to avert maternal and perinatal morbidities .This can ascertain better maternal and foetal health in a country like India.
