November 2017 · Volume 6 · Issue 11 Page 5118 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Dubey S et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):5118-5121 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Original Research Article Referrals revisited: a clinical audit Swati Dubey*, Sumita Mehta, Sonam Singh, Anshul Rohatgi INTRODUCTION Pregnancy and childbirth are physiological processes; however, severe maternal morbidity can complicate certain pregnancies, deliveries and puerperium. Approximately 30% of such obstetric cases belong to this high-risk category which collectively accounts for 70- 80% of maternal and perinatal morbidity and mortality. 1 According to WHO, in comparison to a developed country, a woman in a developing country is at 33 times higher risk of dying from obstetrical causes, in her lifetime. 2 UNICEF data estimates that about 800 women die every day due to preventable obstetric causes and 20 per cent of these women belong to India. India’s share of global maternal deaths is 17%, with 55,000 women dying of preventable obstetric causes annually. 3,4 Maternal Mortality Ratio (MMR) reflects the overall health care system of the society and their attitude towards women. India has failed to achieve the Millennium Development Goal (MDG) of decreasing the MMR by 75% by the year 2015 as compared to the year 2010, as reflected in MMR, which reduced from 215 in 2010 to 174 in 2015. 3,4 To prevent maternal/neonatal mortality, the high-risk category needs timely identification and intervention and if need be, prompt referral to higher centres where HDU/ICU level of care is provided. The health care system needs to be ready to manage such high-risk cases with a positive outcome. In our country, healthcare is provided at primary, secondary and tertiary level; therefore, a strong, structured referral system assumes prime importance in meeting this challenge. ABSTRACT Background: Pregnancy and childbirth are physiological processes; however, severe maternal morbidity can complicate certain pregnancies, deliveries and puerperium. To prevent maternal/ neonatal morbidity and mortality, the high-risk category needs timely identification and intervention and if required, prompt referral to higher centres where HDU/ICU level of care is provided. The present study was a clinical audit of obstetric referrals. Methods: A clinical audit of all obstetrics referrals done at BJRM (secondary level facility) from 1 st May to 31 st October 2016. The cases were analysed with respect to demographics, indications for referral and barrier to services. Results: Referral rate of our hospital was 6.52%. Mean age of women referred was 24.16 years. The associated risk factors were PIH in 36.17%, anaemia in 34.04%, followed by thrombocytopenia and diabetes in pregnancy. Majority of referrals were done in women during labour 93.94% while only 3.03% referrals during post-partum period. Most common indication was MSL with foetal distress 20.96%, followed by hypertensive disorders in pregnancy 16.93%. Other indications were APH, malpresentation, 2 nd stage arrest and cord prolapse. The main barriers to providing services at our institute were unavailability of 24 hours OT services, blood bank and ICU care. Conclusions: Standard referral protocol and well-defined linkages need to be established so as to have better co- ordination between the referral units and tertiary centres. Keywords: Barrier in referral service, High risk pregnancy, Obstetric referral, Referral protocol Department of Obstetrics and Gynecology, Babu Jagjiwan Ram Memorial Hospital, Jahangirpuri, New Delhi, India Received: 12 September 2017 Accepted: 05 October 2017 *Correspondence: Dr. Swati Dubey, E-mail: minidubey23@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. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175036