Clinical, Aociodemographic Profiles, and outcomes of Mothers Referred to three Teaching Hospitals for Tertiary Care: Addis Ababa, Ethiopia: Prospective Cross-Sectional Study
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Date
2024-10-15
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Addis Ababa University
Abstract
Background: The referral system is crucial for ensuring that patients have access to emergency obstetric care during pregnancy and labor since the promptness and appropriateness of the referrals affect the patients' final prognosis. One of the best interventions to improve the devastating feto maternal outcomes of laboring women is early detection of problems and immediate referral to a better health care service provider.
Objective: To determine the feto-maternal outcomes and associated factors among pregnant women referred for labor and delivery service to the three teaching hospitals.
Method: Institution based cross sectional study was conducted to determine the fetomaternal outcome and associated factors among 411 mothers who came referred to the three teaching hopitals in Addis Ababa from February 1 to May 30, 2024. Systematic sampling technique was used to select mothers referred for labor and delivery. Data were entered and analyzed by statistical package for social sciences window version 26.The data was analyzed by logistic regression using 95% confidence level and P-value of less than 0.05 and multivariable logistic regression model was used to identify theassociated factors.
RESULT: A total of 411 women referred for labor and delivery services were included in this study. The most common reasons for referral to the tertiary hospital were dystocia or (labor abnormality), which accounted for 21.7% of the referrals, followed by fetal distress (11.4%) and pregnancy-induced hypertension, which accounted for 9.7% of the referral cases. Adverse maternal and fetal outcomes happened in 8% and 33% of referred mothers, respectively. Determinant factors for poor maternal outcome were not having ANC (AOR=3.3, 95%CI=1.87, 12.83), arrival before 30 minutes of referral (AOR=3.1, 95%CI=1.27, 7.69), mode of delivery by instrumental and ABD (AOR=8.9, 95%CI=2.03, 39.67 & AOR=7.3, 95%CI=5.54, 49.38, respectively), and having poor perinatal outcome (AOR=2.9, 95%CI=1.17, 7.57). The determinant factors for poor perinatal outcome were being illiterate (AOR=1.8, 95%CI=1.15, 4.96), not having ANC (AOR=4.7, 95%CI=2.15, 12.42), initiation of ANC in the third trimester (AOR=7.5, 95%CI=1.16, 48.20), referral at night (AOR=1.6, 95%CI=1.04, 2.59), and taking more than 30 minutes to arrive after referral (AOR=2.5, 95%CI=1.41,4.35). 8
CONCLUSION: The study revealed that lack of ANC and delayed initiation of ANC are among the main factors that contributed to adverse maternal and fetal outcomes among referrals. Giving more attention to those parts of the population who didn't attend formal education and implementing earlyreferral practice will improve adverse maternal and fetal outcomes.
Key word: Referral system, maternal outcomes, perinatal outcomes, laboring mother
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Referral system maternal outcomes maternal outcomes maternal outcomes laboring mother, , ,