Marwah Sheeba, Suri Jyotsna, Shikha Taru, Sharma Poornima, Bharti Rekha, Mann Mohit, Ete Geyum, Shankar Nivedita, Bajaj Bindu
Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Indian J Crit Care Med. 2024 Aug;28(8):734-740. doi: 10.5005/jp-journals-10071-24762. Epub 2024 Jul 31.
In resource-limited facilities, the greatest number of unfavorable maternal-fetal outcomes at referral hospitals is chronicled from emergency obstetric referrals of critically ill patients from lower health facilities. An efficient obstetric referral system is thus necessitated for improving maternal health. Referral practices have not been optimized effectively till date, owing to paucity of a detailed profile of referred women and indigenous barriers encountered during implementation process.
This five-year retrospective audit was conducted in the Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi from September 2018 to 2023, in which records of all critically ill obstetric women referred were reviewed. The primary outcomes included were proportion and pattern of patients being referred, while secondary outcomes included demographic variables, referring hospital, reason and number of steps in referral, duration of hospital stay and fetomaternal outcome. The data were recorded on a predesigned case proforma and analyzed using the SPSSv23 version of software, after application of appropriate statistical tests.
The referral rate to obstetric intensive care unit (ICU) ranged from 39 to 47% in last 5 years; hypertensive disorder of pregnancy (31%) being the foremost cause of the referrals. Around 2/3rd women were transferred without escort (70%) or prior communication (90.6%) and referral slips were incomplete in half the admissions.
Ensuring emergency obstetric care (EmOC) at various levels by up-gradation of health infrastructure would go a long way in improving fetomaternal health outcomes. There is need of standardized referral slips tailor-made to each state and contextualized protocols for early recognition of complications and effective communication between referral centers.
Marwah S, Suri J, Shikha T, Sharma P, Bharti R, Mann M, . Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India. Indian J Crit Care Med 2024;28(8):734-740.
在资源有限的医疗机构中，转诊医院中最不利的母婴结局大多记录于来自下级医疗机构的危重症患者的紧急产科转诊。因此，需要一个高效的产科转诊系统来改善孕产妇健康。由于缺乏转诊妇女的详细资料以及实施过程中遇到的本土障碍，转诊实践至今尚未得到有效优化。
2018年9月至2023年，在新德里的VMMC和萨夫达容医院妇产科进行了这项为期五年的回顾性审计，审查了所有转诊的危重症产科妇女的记录。主要结局包括转诊患者的比例和模式，次要结局包括人口统计学变量、转诊医院、转诊原因和步骤数量、住院时间以及母婴结局。数据记录在预先设计的病例表格上，并在应用适当的统计检验后使用SPSSv23软件进行分析。
过去5年中，产科重症监护病房（ICU）的转诊率在39%至47%之间；妊娠高血压疾病（31%）是转诊的首要原因。约三分之二的妇女在无护送（70%）或未事先沟通（90.6%）的情况下被转诊，且一半的入院转诊单不完整。
通过升级卫生基础设施确保各级的紧急产科护理（EmOC），将对改善母婴健康结局大有帮助。需要为每个州量身定制标准化转诊单，并制定因地制宜的方案，以便早期识别并发症并在转诊中心之间进行有效沟通。
马尔瓦S，苏里J，希卡T，夏尔马P，巴尔蒂R，曼恩M，. 危重症产科患者的转诊审计：来自印度一家三级医疗保健机构的五年回顾。《印度重症医学杂志》2024；28（8）：734 - 740。
