International Journal of Clinical Obstetrics and Gynaecology

Background: Maternal mortality remains a significant concern in India, despite national initiatives aimed at promoting institutional deliveries and risk-based antenatal care. Delays in accessing appropriate care often due to inefficient referral systems, lack of transport, and resource constraints continue to impact maternal and neonatal outcomes. While a three-tiered referral structure exists, it is frequently undermined by poor coordination, non-standardized protocols, and infrastructure deficits at lower levels.

Objectives: To determine the referral process in obstetric care and its impact on feto-maternal outcomes.

Material and Methods: A prospective observational study was conducted over 18 months at the Department of Obstetrics and Gynecology, a tertiary care hospital in Northern India. The study included 450 obstetric patients (>28 weeks gestation) referred to from other health facilities. Data on referral details, transport, delays, maternal complications, and neonatal outcomes were collected using a structured proforma and analyzed using SPSS v24.0.

Results: Most referrals were term pregnancies (66.9%) and para 2 (41.8%), with 52.4% aged >30 years. Although 70.4% received treatment within 6 hours, delays were commonly due to intermediate referrals, poor transport, and ignored warning signs. Referrals were mainly from PHCs (45.8%), often due to lack of blood, ventilator support, NICU, or specialists.Sepsis (106) was the most common maternal outcome, followed by no complication (87), hypertensive disorders (84), anemia (83), and PPH (72). Most neonates had good outcomes, with 12 IUFD/stillbirths, 231 NICU admissions, majority >2.5 kg, and Apgar <5 in 110 at 1 min and 120 at 5 min.