Outcome of Obstetric Referrals to a Tertiary Referral Hospital in Northern Uganda

Abstract

Abstract: Objectives: To review the obstetric referrals, source of referrals, and document the maternal and perinatal outcomes. Method: A Prospective Observational study reviewed 780 eligible obstetric referrals, ?28 week’s gestation, referred to the hospital for a period of 12 months were analyzed with SPSS version 23. The inclusion criteria were referred cases in the study period. Results: Obstetric referrals accounted for 16.3% (780/4799) of the total admissions, 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. The 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) were transferred out undelivered, 1.2% (09) missing outcome while the 3.6% (28) had 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 hemorrhage; and behind these there were many near misses which would provide valuable information on the quality of care at the periphery facilities. Neonatal outcomes were 80.4% (627) live babies, 10.5% (82) were FSB/MSB and 10% had APGAR score ?5 at 5 minutes of birth while 13.2% of the recorded weights were low birth. Conclusion: A wide spectrum of complicated and uncomplicated obstetric cases were referred to this hospital and majority were unjustifiable. Unavailability of comprehensive emergency obstetric care (CEMONC) was the most common reason for referrals. Most common diagnosis at the time of referral was prolonged/obstructed labour. Even today, obstetric hemorrhage is the leading cause of maternal mortality while prolonged/obstructed labour contributed to the high neonatal mortality. Majority of the referred conditions could be managed at the CEMONC sites; could this be a lacunae in the human resource and supplies to handle these cases as most referrals were unjustified.