Maternal and fetal outcomes of patients referred from primary health-care facilities to a tertiary hospital: A cross-sectional study
- Author:
Rhacielle Cristina C. Magno
1
;
Ma. Bernadette R. Octavio
1
Author Information
- Publication Type:Journal Article
- Keywords: Fetal outcome; Maternal morbidity and mortality; Maternal near miss
- MeSH: Maternal Mortality; Fetus; Morbidity
- From: Philippine Journal of Obstetrics and Gynecology 2021;45(2):61-67
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates.
Materials and Methods:A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management.
Results:There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births.
Conclusion:Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes. - Full text:PhilippJObstetGynecol45261-2161287_060012 (1).pdf
