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Dr. Yuda Munyaw

Appropriateness, timeliness and perinatal outcomes of obstetric referrals managed by caesarean section: A prospective observational cohort study

Obstetric referrals managed by caesarean section (CS) were compared to nonreferral CS at Haydom. 10 353 deliveries were studied: 7.4% (768) were referrals, and 41.5% (319) of these ended with CS versus 22.5% (2152) among nonreferrals. Referred women more often arrived in 2nd stage of labour with complications, ending in CS compared to nonreferrals (p < 0.001). Factors associated with CS (odds ratio) in the referral group were previous CS (11.06), abnormal foetal heart rate (4.96), breech presentation (4.61) and thick meconium (3.61). The referral group had higher proportions of stillbirths and neonatal admissions compared to nonreferrals (p < 0.001).
Conclusion: Referred women arrived late with complications ending with CS and adverse perinatal outcomes. Earlier identification of complications and timely referral from lower‐level facilities may prevent adverse outcomes.