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ABSTRACT
Background: A good and effective referral system is needed to prevent maternal deaths and related complications. Aim: To analyze patients who were admitted in the emergency after 34 weeks for obstetric reasons after 34 weeks of gestation. Material and Methods: A retrospective study was undertaken in Obstetrics & Gynecology of south Indian tertiary care hospital of Government medical college Ernakulum, Kerala, India. Data recorded were baseline demographics, weeks of gestation, common causes for referrals and medical complications if any was recorded. Statistics: Descriptive statistics like percentages were used for analysis. The variables were noted and expressed as percentages. Results: The maximum age was between 21-30, 31-40 and < 20 years with 62.1%, 24.1% and 13.8% respectively. Primigravida referrals was 57 (49.1%) followed by gravida 2 (31.0%), gravida 3 (14.7%), gravida 4 (4.3%) and gravida 5 (0.9%). Among referred patient, 57 (49.1%), 21 (18.1%), 19 (16.4%), 8 (6.9%), 5 (4.3%) and 1 (0.9%) were between 34-36, 36-37, 37-38, 38-39, 39-40 and >40-42 weeks respectively. Among morbidity, 13 (11.2%) cases of preterm premature rupture of the membranes (PPROM) and oligohydramnios. in this study 4 (3.4%) were for baby’s sake, 10 (8.6%) cases were previous caesarian section and 12 (10.3%) were preeclampsia, 17 (14.7%) cases were fetal growth restriction (FGR) with abnormal doppler and 33 (28.4%) were with preterm pain. Among medical complications, about 26 (22.4%) with gestational hypertension, 22 (19.0%) thyroid disorder and 15 (12.9%) with gestational diabetes mellitus were more in number and about 49 (42.2%) of the patients did not had any medical complications. Conclusion: Prompt and timely referrals of eligible patients are needed to prevent medical complications and improve health care system in developing country as evident from this study.

Keywords: Obstetric referral, Periphery, Tertiary care centre, Maternal death, Medical complications