AUDIT OF OBSTETRIC REFERRED CASES IN TERTIARY CARE HOSPITAL OF PESHAWAR

Abstract

Objective: This study aimed to determine obstetric referral characteristics and their causes.

Methods: This prospective observational study was conducted in the Gynae B unit, Khyber Teaching Hospital, Peshawar, Jan 1st, 2021 - Dec 31st, 2021. All obstetric cases referred to this hospital in the study period were included. Detailed clinical history, including the age, parity, period of gestation if antenatal, and place of referral, were recorded. A thorough general physical and obstetrical examination was performed, and required investigations were sent. The patient's treatment, including vaginal delivery, cesarean section, and conservative management, was recorded. Data analysis was done using SPSS 22.0.

Results: Total obstetric admissions during the study period were 5,242; total referrals for obstetric indications were 1,678, constituting 32% of all obstetric admissions. 1241 (74%) of cases fall within the age group of 20-30, while 234 (14%) were under 20 years old and 201 (12%) were over 30 years. 588(35%) of patients were prim gravidas, 453(27%) were multi and 335(20%) were grand multigravidas. 56% of patients presented during antenatal, while 604 (36%) arrived intrapartum and 302 (18%) postpartum. The mode of transport used by the referred patients was an ambulance in 369(22%) and private vehicles in 1308(78%) cases. The most common reasons for obstetric referrals were hemorrhagic disorders, accounting for 28%, and hypertensive disorders, which made up 18%.

Conclusion: Complex obstetric cases are referred to our tertiary care facility. A proper referral system is needed for tertiary care-level hospitals. The process of transferring patients between hospitals highlights the importance of teamwork. It is necessary to acknowledge that tertiary care is the only option for high-risk referrals.