Incidence of Adverse Pregnancy Outcomes Between Referred and Non-referred Patients With Obstetric Emergencies at Longisa County Referral Hospital June, 2013-2020

Abstract

Background: Approximately 99% of deaths occurring in developing countries are as a result of obstetric emergencies. The World Health Organization estimates that globally, there are around 358,000 women who die annually from obstetric emergencies. Most of these deaths are preventable through integrate of quality services as well as ensuring prompt response to healthcare needs of pregnant women. Developing countries have been characterised with poor referral systems which increase preventable mortality associated with obstetric emergencies. There is need to understand occurrence of obstetric emergencies from referrals as well as nonreferral cases within local context. The purpose of the study: To determine the differences in the incidence of adverse pregnancy outcomes among patients referred versus non-referrals with obstetric emergencies at Longisa County Referral Hospital between June, 2013-2020. Methodology: The study adopted a retrospective cohort study. The study targeted referral and non-referral women with obstetric emergencies admitted at Longisa County Referral Hospital. A systematic sampling technique was used to select 604 referral women and 604 non-referral women who meet the inclusion criteria. The data abstraction tool was uploaded into Google form and used for data entry from the patient files. Epi-data 3.1 was used for data entry and then exported to Statistical Package for Social Sciences (SPSS version 26). Data collected included whether the patient was a referral or not, socio-demographic and clinical characteristics, indications for admissions, maternal and perinatal outcomes. Results: The findings showed that women who were referred compared to non-referrals were seven times more likely to have obstructed labor (RR = 7.0, 95%CI: 3.0 – 16.34, p<0.001). Patients who were referred compared to non-referrals were two times more likely to have hemorrhage (RR =2.16, 95%CI: 1.27 – 3.68, p = 0.003), 2.4 times more likely to have intrauterine fetal death (RR=2.42, 95%CI: 1.48 – 4.09, p<0.001), less likely to have established labor (RR =0.31, 95%CI: 0.25 – 0.76, p<0.001). Among patients who were referred compared to non-referred patients, the risk of maternal adverse outcome was 53% higher (RR = 1.53, 95%CI: 1.16 – 2.01, p = 0.003), 1.8 times more likely to have PPH (RR = 1.82, 95%CI: 1.29 – 2.58, p<0.001, three times more likely to have AKI (RR = 3.75, 95%CI: 1.25 – 11.24, p =0.009. The risk of maternal mortality was three times higher among referrals compared to non-referred patients (RR =3.0, 95%CI: 1.28 – 7.01, p= 0.006) The findings revealed that women who were referred compared to non-referrals were 1.1 times more likely to have adverse perinatal outcome (RR =1.06, 95%CI:1.02 – 1.11, p =0.001), 1.34 times more likely to be admitted in NBU (RR =1.34, 95%CI: 1.22 – 1.46, p<0.001, 1.4 times more likely to have intra-uterine fetal demise,(RR = 1.37, 95%CI: 1.14 – 1.66, p =0.001. The risk of perinatal mortality was 50% higher among referrals compared to non-referrals (RR =1.5, 95%CI: 1.26 – 1.8, p<0.001 Conclusion: The study has established that common indications for admission that were significantly higher among referrals included obstructed labor, intrauterine fetal death, meconium staining, prolonged labor and cord prolapse. The incidence of adverse maternal outcomes was higher in referral compared to non-referral cases with PPH and AKI being significantly higher in referral cases. Perinatal adverse outcomes were significantly higher among referral cases compared to non-referral case with higher risk among referral in NBU admission and perinatal mortality. Recommendations: Employment of more medical personnel (reproductive health specialist, medical officers, reproductive health officers, midwives) by the County Government; Establishment of clear referral system between lower level facilities and referral hospital; Empowerment of level four hospital by improving infrastructure (theatres, imaging services, NBU.) and trained personnel; Capacity building of medical personnel by organising CME’s, workshops and EmONC, More studies: prospective study to evaluate the same; other studies to evaluate on neonatal outcome after admission to NBU. Giving feedback to LCRH on the findings of the study.