Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India

BACKGROUND: The maternal mortality ratio in India is high. An effective emergency obstetric care (EmOC) strategy has been identified as a priority to reduce maternal deaths. Since the capacity of different levels of public health facilities to provide EmOC is varied, an effective referral system is crucial. However, few studies have evaluated the functioning and quality of referral systems in India. A systematic monitoring of referrals helps to identify current gaps in the provision of essential obstetric care. OBJECTIVE: This study was conducted to identify the medical and logistic reasons for emergency obstetric referrals from a subdistrict hospital (SDH). METHODS: An audit of emergency referrals during the period January 2015–December 2015 was carried out. Records of all obstetric patients referred from the maternity ward during the study period were reviewed. RESULTS: The referral rate was found to be 31.7%. Preterm labor (30.6%), pregnancy-induced hypertension (17%), and fetal distress (10.6%) were the main reasons for referral. Deficiencies were found in critical determinants of functionality, that is, nonavailability of emergency cesarean, neonatal care unit, and blood bank. CONCLUSIONS: The referral rate at the SDH was high. Lack of workforce and infrastructural facilities led to referrals of women who ought to have been managed at this level of the hospital.