Inter-hospital obstetric referrals: public versus private sector to a tertiary care teaching hospital in South Kerala, India

Background: Inter-hospital Emergency obstetric transfers should be carried out effectively and efficiently to avoid maternal and fetal morbidity and mortality. Authors would like to analyse the determinants ,patterns and reasons for referrals to tertiary hospital for women with obstetric high-risk, complications and obstetric emergencies from both public and private sectors and look into course in hospital and their feto-matermal morbidities.Methods: Descriptive study done at a tertiary care teaching hospital where 124 obstetrical referrals from nearby private and public health sectors were recruited.Results: Infertility treated obstetric referrals were at significant risk of referral (p value-0.002). Public sector referrals had past history of early pregnancy loss which was significant (p value-0.002). Public sector had statistically significant in -labour referrals (p value-0.04). All the obstetric referrals from public health sector reached within half an hour while one third of private sector referrals travelled more than an hour for emergency obstetric care (p value 0.001). Bronchial Asthma caused significant morbidity among public sector referrals (p value-0.001). Public sector referrals <31 weeks were nil while 55 % obstetric referrals were referred <31 weeks from various private hospitals seeked neonatal care with significant p value (0.016). NICU admissions were statistically significant in private sector referrals (p-value 0.001). Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Specific guidelines for whom to refer, how to refer, when to refer and where to refer would be helpful in making timely referral. More stringent documentation in the referral slips and more co-ordination between the referral unit and the higher centers are required to build a strong health system.