An appraisal of the referral system and outcome for obstetric patients referred to a tertiary centre

Abstract

The existing referral system from primary institutions to higher institutions within our health district for obstetric patients has not been subjected to any analysis of shortcomings. We therefore made an assessment of resultant adverse maternal, foetal and neonatal outcomes by a prospective observational cohort study done over a 6-month period at a tertiary centre. Data were collected from 317 patients. We found an important failure to identify high risk patients at primary institutions. This resulted in an increased overall adverse outcome five-fold, adverse maternal outcome seven-fold, adverse neonatal outcome six-fold and stillbirth four-fold. Ongoing training and use of updated guidelines are our urgent recommendations.