OBSTETRIC REFERRALS AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE (SPHMMC): PRE-REFERRAL CARE AND APPROPRIATENESS

Abstract

ABSTRACT
BACKGROUND: Referrals between health care facilities is crucial in emergency obstetrics care to ensure appropriate level of care to women and newborns. The timely decision and appropriate pre-referral care will significantly affect maternal and perinatal outcome.
OBJECTIVE: The aim of our study was to assess the pre referral care and referral appropriateness of mothers referred to SPHMMC. METHODS: A cross sectional study was conducted that involved all mothers referred to SPHMMC for obstetric emergency from January 25 to March 5, 2017. They were interviewed at emergency department and the pre-referral care given and the process of patient transfer was assessed using a structured tool. Data was entered cleaned and analyzed using SPSS Version 22. Descriptive statistics and Pearson correlation was used to present results assess the relationship between referral and arrival diagnosis.
RESULT: A total of 1080 mothers were transferred to SPHMMC from BEmONC centers during the study period. Majority of clients 718(65.5%) were from outside Addis Ababa and 362 (33.5%) of clients were from Addis Ababa. Prolonged labor, PROM, PIH and abortions constitute the top referral diagnosis accounting for 21.8%, 16.5%, 10.4% &9.9% in that order. Two thirds (68.6%) of the clients were transferred without prior notifications to the hospital. Most (96.5%) of those patients transferred with prolonged or obstructed labor were transferred without attachment of their Partograph. With regards to the intervention provided at referring health facility 170 (72.3%) of prolonged/obstructed labors were transferred without intravenous access line; 90 (75.4%) of patients with premature rupture of fetal membranes were not given antibiotics before referral, 89 (79.5%) of preeclampsia/eclampsia cases were not provided with magnesium sulphate as seizure prophylaxis and of those laboring mothers diagnosed to have fetal distress on referral, 45 (60.8%) were referred without securing intravenous line for resuscitation. CONCLUSION AND RECOMMENDATIONS: We found that most clients were coming from non-catchment health facilities without prior notification. In the majority of cases essential pre-referral care were not initiated at the referring facilities for those women with obstetric complications. BEmONC facilities need to be strengthened to offer the required medical interventions to save lives at the site and during transfer of patients.
KEY WORDs: BEmONC, CEmONC, SPHMMC, Ethiopia.
(Ethiopian Journal of Reproductive Health; 2019; 11;2:10-16)