Obstetric risk assessment and referral to tertiary healthcare facilities from primary and secondary healthcare settings in Nigeria

Abstract

Obstetric risk assessment is an integral part of obstetric care needed to classify patients into low and high risk categories, thereby aiding appropriate referral cascade. Unfortunately, in Nigeria, its effectiveness is saddled with uncertainty. The aim of the study therefore was to determine the appropriateness of obstetric risk assessment and referral from primary and secondary healthcare facilities to the tertiary Centre Rivers State University Teaching hospital (RSUTH) in Rivers State, Nigeria. It was a prospective cross-sectional study involving 475 patients who were managed on admission to the labour ward and the appropriateness of their referrals was assessed, using a preformed evidence-based guideline. The outcome measures were as follows: percentage of patients that had appropriate risk assessment, referred appropriately, referred late and those that needed referral at booking. Data was analysed using Epi Info 2020. Out of the 475 study population, only 50 (10.53%) were of low risk category at presentation and were appropriately referred when complications developed in pregnancy. 15 (3.16%) of them, although of low risk at booking, needed earlier referral when complications developed while majority 410 (86.32%) were of high risk category because they either had complications in their previous pregnancies or had pre-existing diseases or both and therefore needed to be referred at booking (11-13+6 weeks) but were not. The findings underscored the urgent need for structured retraining of skilled obstetric practitioners in both primary and secondary healthcare settings in Rivers State.