STUDY OF MATERNAL AND FETAL OUTCOME IN REFERRED AND BOOKED CASES AT GRMC, GWALIOR

Abstract

Introduction: Provision of adequate and timely emergency obstetric care (EmOC) has been recognized as the most important intervention for saving lives of pregnant women who may develop complications during pregnancy or childbirth. The operationalisation of First Referral Unit at sub-district/CHC level for providing EmOC to pregnant women is a crucial strategy of RCH-II, which needs focused attention. In antenatal period early registration regular visits, improvement in maternal nutrition, high risk identification, institutional deliveries by skilled birth attendants, prompt and timely referral to a hospital for appropriate interventions and management would be the measures needed to make motherhood safe.

AIM: To study the demographic profile of referred and booked pregnant women in labour, the maternal and perinatal outcome, indication of referral, mode of delivery and the rate of operative interference in referred verses booked cases.

MATERIAL AND METHOD: Present study is a prospective hospital based, randomized observational study conducted in Department of Obstetrics and Gynaecology, GRMC, Gwalior MP from July 2017 to September 2018. The present study comprises demographic profile of 72 referred versus 72 booked pregnant women in labour who were admitted. Documentation related to referral from PHC, CHC or district hospital was obtained from referral slips and relatives to ascertain her to be a referred case. Booked cases were taken randomly as control.

RESULTS: In referred group 50.92% and 65.27 % in booked were between 21-25 yrs of age group. While 30.5% referred and 18.0% in booked were between 26-30 yrs. In referred group 5.5% women were brought in very poor condition and needed resuscitation. Condition was not satisfactory in 18.0% referred and 12.0% in booked cases also. In referred group indication of CS was 17.44% in obstructed labour, 10.46% due to fetal distress, 9.30% previous section, 15.11% breech and 9.30% CPD. In referred group 74.07% babies were born as alive & healthy, 1.38% was fresh still born, 6.48% IUD. 14.81% babies required nursery care, 3.24% babies died within 7 days. In referred group total perinatal deaths were 11%, while 1.85% in booked. In refereed group (45.0%) were referred from PHC, (30.0%) from CHC and (24.46%) from district hospital. 91.20% of cases had 1^st referral. Only 8.79% of cases had 2^ndreferral.

CONCLUSION: We need to ensure every woman the right to safe motherhood. In making pregnancy safer, three factors are vital- 1. Every pregnancy should be wanted. 2. All pregnant women must have access to skilled care. 3. All pregnant women must be able to reach a functioning health care facility when complications arise.