Rationale for referral and pregnancy outcomes of women referred during labor in Soroti Regional Referral Hospital

Abstract

Introduction: Maternal referral during labor has been found to be associated with poor pregnancy outcomes. Globally, 15% of pregnancies that develop life-threatening complications required referral to higher health centers. The outcomes of women referred during labor have not been documented in our setting. Therefore, the aim of this study was to determine the pregnancy outcomes and rationale for referral of women during labor at Soroti Regional Referral Hospital. Methodology: This was a cross-sectional study conducted from December 2018 to February 2019 among women referred during labor to Soroti Regional Referral Hospital. A total of 300 who were referred during labor were recruited using consecutive sampling. The interviewer-administered questionnaire and data abstraction forms were used to collect data which included sociodemographic data, referral characteristics, the rationale for referral, and the maternal and fetal outcomes of referrals. Ethical approval was obtained. Data was analyzed using STATA version 14.1. Results: The proportion of referral was 38% in this study. Majority of the referrals were from the health center IIIs, IVs and district hospitals. Obstructed /prolonged labour 74% was the most common maternal indication for referral. Non-reassuring fetal heart 59% was the leading fetal indication for maternal referral. Nearly three-quarters 70 % of the referrals were delivered by cesarean section. The neonatal outcomes were stillbirths 9%, admission to NICU 36.6% and early neonatal death 4.8%. Most of the neonatal deaths occurred in the intrapartum period among neonates who were weighing more than 2500g. Conclusion and recommendation: The proportion of referral during labor was 38%. Obstructed labor and non reassuring fetal heart were the common indications for referral. Caesarian delivery and stillbirth were the major outcomes in the study.