Retrospective review of indications for emergency obstetric referrals from Mofolo community health centre to Chris Hani-Baragwanath hospital
Objectives: To determine the referral rate, clinical indications, and ambulance response time for Emergency Obstetric Care referrals from Mofolo maternity obstetric unit (MOU) to CH Baragwanath Hospital (CH-B). Method: A retrospective comparative study of the admission book records of women in labour who presented to Mofolo during the first 3 months of 2010 was conducted. Data from 624 presentations in the admission book were allocated into referred and non-referred groups with Excel spreadsheets. Results: There were 317 deliveries at Mofolo MOU, of which 44 (13.9%) were transferred to CH-B after delivery. Referred neonates numbered 21 (6.5%), as 23 neonates accompanied their mothers who were referred. Women in labour that were referred to CH-B numbered 303. Thus, of 624 patients, there were 347 (55.6%) referred to CH-B. Sixty nine women were referred for pregnancy induced hypertension (19.9%). Prematurity referral was 17.7% (31.5 for premature rupture of membranes, 25 for preterm labour and 5 underweight babies; thus 61.5 / 347 = 17.7% of referrals). Partogram delay was the referral reason for 51 women (14.7%), and for meconium- stained amniotic fluid for 14.7%. Average ambulance response time was 48.2 minutes and 55% went by ambulance. Conclusion: Neonatal referral rate at Mofolo MOU was 6.5%; down from the 33% at Chiawelo. The combined referral rate was similar; 55.6% at Mofolo MOU and 58.4% at Chiawelo MOU. This rise may be related to ease of referral process together with the increase in litigation. Mofolo MOU integration into the health district is facilitated by accessible referral path and the choice of transport as 55% went by ambulance.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the degree of Master of Science in Medicine in Emergency Medicine 11 May, 2016