Rationale for referral and birth outcomes for women referred from lower-level facilities to a regional referral hospital in eastern Uganda
Safina Akello, Mariam Namutebi, Epuitai Joshua, Samuel Okello, Patience A MuwanguziBackground/Aims
Globally, nearly 810 women die every day as a result of pregnancy-related complications. Timely and appropriate referral can improve maternal and fetal outcomes and encourage mothers to seek healthcare services early. However, maternal referral during labour is often associated with poor pregnancy outcomes. The aim of this study was to describe the rationale for referral and the maternal-fetal outcomes for women referred during labour from lower-level facilities to a regional hospital in Uganda.
Methods
This descriptive cross-sectional study involved 300 consecutively sampled women referred during labour at >28 weeks' gestation. Data were collected using an interviewer-administered questionnaire and data abstraction tools and analysed using descriptive statistics.
Results
The majority of referrals (78.6%) were from level 3 and 4 health centres and district hospitals. Obstructed or prolonged labour (74.5%) was the most common maternal indication for referral, while non-reassuring fetal heart rate (59.3%) was the leading fetal indication. Nearly three-quarters (70.3%) of the participants gave birth via caesarean section.
Conclusions
Obstructed labour and non-reassuring fetal heart rate were the most common indications for referral. Caesarean section and stillbirth were the major outcomes observed.
Implications for practice
Regional referral hospitals should advocate for and provide supervision to lower-level health facilities that are capable of offering basic emergency obstetric services. Enabling these facilities to perform interventions such as caesarean sections and newborn resuscitation could help reduce the incidence of adverse outcomes and unnecessary referrals.