A Study of Obstetric Referral Cases to Tertiary Care Center in Rural Setting of Mahasamund, Chhattisgarh

Background: An effective referral system is key to access timely emergency obstetric care in order to prevent maternal and perinatal mortality.The criticality of referrals makes it necessary to understand its pattern at the health system level.This study was conducted with an objective to document the patterns, primary reasons of obstetric case referral and the maternal and perinatal outcome of the referred cases in Government Medical College, Mahasamund in rural Chhattisgarh.As a systematic monitoring of referrals majorly helps to identify current gaps and timeliness of referral in providing essential obstetric care.Methods: The study is based on the health records and details on referral forms from referral center and peripheral health facilities.This follow-up study was conducted in between July 2022 and June 2023 (12 months).All referred patients for obstetrics indications above 20 weeks and patients with postpartum indications were included.Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes.Results: According to our study, out of a total of 5,962 delivered patients, 1,281 (20.5%) cases were referred patients.Maximum cases, i.e., 567 (44.2%) were in the age-group of 24-29 years.The major reasons for referring patient were hypertensive disorders of pregnancy (11.2%), previous cesarean section (9.8%), and PPH (9.5%).There were six maternal deaths (0.5%) and discharge rate was 96.2%. Conclusion:The present study showed that illiteracy and ignorance of female regarding healthcare requirements and poor infrastructure came out to be a major contributor of poor pregnancy outcome.Timely referral is crucial for a satisfactory maternal and fetal outcome.To reduce the number of unnecessary referrals and to reduce burden on tertiary care hospitals, healthcare workers should be trained in essential and emergency obstetric care which will help in reducing morbidity and mortality.