Emergency obstetric referrals in public health facilities: A descriptive study from urban Maharashtra, India

The study focuses on the emergency obstetric referral system in public health facilities in urban Maharashtra, India, particularly in the Mumbai Metropolitan Region. It aims to understand the patterns and primary reasons for obstetric case referrals, as well as the maternal and perinatal outcomes of these cases. The data was collected from municipal hospital records between 2016 and 2019, covering 33 maternity, 16 peripheral, and 4 tertiary hospitals.

The study revealed that 14% of pregnant women were referred to higher health facilities, primarily due to conditions like pregnancy-induced hypertension, previous caesarean sections, fetal distress, and oligohydramnios. Non-medical reasons for referrals included unavailability of human resources and health infrastructure, such as emergency operation theatres and neonatal intensive care units. The study also highlighted that only 47% of referrals involved phone-based communication between referring and receiving facilities, and 60% of the referred women could be tracked at higher health facilities.

The findings emphasize the need for improved referral processes and communication between healthcare facilities to enhance the performance of emergency obstetric care. The study suggests upgrading health infrastructure and establishing a formal communication and feedback system to ensure timely and effective referrals. It also underscores the complexity of the urban referral system, which is often challenged by inequitable distribution of health facilities, unsuitable distances from urban informal settlements, and overloaded tertiary hospitals. The study concludes that strengthening the referral mechanisms and improving the capacity of primary and secondary healthcare facilities are crucial steps towards reducing maternal and perinatal mortality in urban India.