Emergency obstetric referrals at a University Teaching Hospital, Nigeria

Abstract

Objective: To identify factors in our unbooked obstetric emergency cases that contribute to the increase in maternal mortality. Design: A retrospective study. Setting: Maternity Ward, University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1966 and December 1999. Subjects: Four hundred and thirty five cases of emergency obstetric referrals treated during the review period. Results: The incidence of unbooked obstetric emergencies is 9.5% and the high risk obstetric group, the primigravida and grand multiparous women constituted 63% of it. Majority (80%) of the patients belonged to the lower socio-economic class and prolonged and obstructed labour were the commonest mode of presentation. Sources of referrals were hospital/clinics (46%), maternity homes (23%), traditional birth attendants (TBAs)(16%) and prayer houses (2.3%). There were obvious delays at the referral sources and most of the patients presented in poor clinical states. Forty per cent of total maternal mortality in the hospital were attributed to unbooked cases with haemorrhage and sepsis being the major causes. Also perinatal mortality of 40.2% was recorded. Conclusion: Lack of basic education and poverty are the major identifiable risk factors. Improving health care facilities, female education, regular training courses for medical personnel and elimination of quacks are advocated.