Relationship between place of referral and birth outcomes among women with Obstetric emergencies at Tenwek hospital in Bomet county, Kenya

Abstract

Background: Effective and timely maternal referral is important in obstetric emergencies since most pregnancy complications are unpredictable and progress rapidly to become life threatening. One of the aims of the Kenya Essential Package of Health is provision of adequate and timely referral system, basic and comprehensive emergency obstetric care to pregnant women and their newborns. Timely recognition of obstetric complications and management is crucial in reducing adverse obstetric outcomes. The study was carried out to determine outcomes among self-referred and facility referred women requiring emergency obstetric care. Objective: To determine maternal and perinatal outcomes among women with obstetric emergencies referred to Tenwek Hospital in Bomet County. Study design and Methodology: Cross-sectional study of 200 mothers who presented with obstetric emergencies in labour or within 24 hours postpartum. Approval was sought from MTRH/Moi University Institutional Research and Ethics Committee and Tenwek Hospital Research Committee. Datawere collected using interviewer administered questionnaire and review of medical records and summarized using descriptive statistics. Chi-square test was used to compare the maternal and perinatal outcomes in facility and self-referred patients, and in those appropriately and inappropriately referred women. A p value of < 0. 05 was considered statistically significant. Results: We recruited 200 women who presented with obstetric emergencies in labour or within 24 hours postpartum during the study period. The mean age of participants was 27.7 years (SD ± 11.2) with 50% having had at least 4 antenatal clinic visits. Most of the participants (59%) were self-referrals with 41% having been referred from health facilities. Lack of medical supplies and appropriate health personnel were the main reasons for health facility referral (95.1%). Majority of the women were escorted by relatives (83.5%) and used public means for transport (85%). Only 8% of the participants used ambulance for referral. Sixty eight percent of the women had normal outcomes and normal perinatal outcomes were 109(54.5 %). Thirty two percent of referred mothers had adverse outcomes that included severe postpartum hemorrhage, and complications arising from eclampsia. Adverse perinatal outcomes included neonatal morbidity (30.7%), stillbirths (13.2%) and neonatal mortality (1.6%). Those who were appropriately referred had higher proportion of abnormal maternal outcomes (48.8%) compared to those inappropriately referred (χ2=7.137, p=0.008). Place of referral was not associated with adverse maternal outcomes (χ2 = 1.405, p=0.236). Perinatal outcomes were not significantly associated with place of referral (χ2 = 2.256, p = 0.132) or appropriateness of the referral (χ2=0.436, p=0.509). Conclusion: Lack of medical supplies and skilled birth attendants remain key reasons for referral. Most of the women and neonates had normal outcomes. Women who were appropriately referred due to obstetric emergencies had significant adverse maternal outcomes compared to those who were inappropriately referred. Recommendation: Ensure provision of essential medical equipment and supplies and provision of health personnel to lower tiers of care as per the norms and standards.