May 2023 · Volume 12 · Issue 5 Page 1237 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Patel P et al. Int J Reprod Contracept Obstet Gynecol. 2023 May;12(5):1237-1242 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Original Research Article Evaluation of maternal care at different level of health care facilities and referral scenario in Northern Madhya Pradesh and its effect on fetomaternal outcome Priyanka Patel*, Palas Ganvir, Sheela Jain INTRODUCTION Pregnancy and childbirth are a universally celebrated event. Yet for many women this joyful event is associated with various complications which may end in death. 1 Various government and non-government organizations are working for creating awareness and providing facilities regarding ANC and safe delivery practices. Despite the provision of improved facilities, there is a public health concern about high maternal mortality and perinatal mortality. 2 ANC at ground level is provided by various frontline health workers through primary health centre to detect high risk cases as early as possible. The objective of ANC is to detect high risk cases and refer them to tertiary care centre and arrange for them skilled care. The referral system plays a very crucial role in pregnancy and childbirth for providing access to emergency obstetrics care (EOC). Appropriateness and timeliness of referral is important is an important factor in the ultimate outcome of patients. 3 Despite the provision of good antenatal services and attempt to increase awareness, services are poorly utilized and hence the patients present in late stage with complication which are difficult to manage. This increases the suffering and morbidities of the patients. Present study was conducted at Bundelkhand medical college, Sagar Madhya Pradesh. Being a tertiary care hospital, it caters the patients referred from different parts of Bundelkhand region. Also, it caters population of various nearby DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20231202 Department of Obstetrics and Gynecology, Bundelkhand Medical College Sagar Madhya Pradesh, India Received: 04 April 2023 Accepted: 19 April 2023 *Correspondence: Dr. Priyanka Patel, E-mail: patelpriyanka8984@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Pregnancy and childbirth especially in high-risk women necessitate proper antenatal, intranasal and immediate post partum care. Lack of knowledge, ignorance and poor transport facilities are major contributors of poor pregnancy outcome. Early detection of complications and prompt referral to higher centre is crucial in improving maternal outcome. Methods: This retrospective observational study was conducted in 700 consecutive patients who attended the department of obstetrics and gynecology Bundelkhand medical college, Sagar Madhya Pradesh. India from 1 st January 2021 to 30 th July 2022. Results: Out of total patients included maximum referrals were from CHC (community health centre) i.e., 49%, followed by 25.5 and 14.6% referrals from DH (district hospital) and PHC (primary health centre) respectively. Majority of referrals from outside located CHC from Sagar district. Maximum referral reported during third trimester i.e., 58.4 and 79.2% from inside and outside Sagar respectively. Overall majority of patients referred belonged to the age group of 21 to 30 years (76.6%) and there was not significant (p=0.41) correlation between inside and outside referral. Conclusions: Maximum referrals reported during third trimester i.e., 58.4% and 79.2% from inside and outside Sagar Districts respectively and there was statistically significant correlation (p=0.01). Antenatal care (ANC) outcome at tertiary health centre can be improved by up grading health care facilities at various peripheral health care centres. Keywords: Emergency obstetric care, ANC, Tertiary care centre