Inter-hospital emergency obstetric referrals to the labour ward of RIPAS Hospital

Abstract

Inter-hospital emergency obstetric transfers should be carried out effectively and efficiently to avoid any complications to either mother or pregnancy. To date, no relevant data are available in Brunei Darussalam. This study prospectively assesses the strengths and weaknesses of the inter- hospital transfer process to the Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital. Materials and Methods: Obstetric patients (n = 92) who were transferred from other hospitals to RIPAS Hospital over a six month period (1st September 2009 to 28th February 2010) were studied. Results: The prevalence of emergency obstetric transfers was 3.65% of total obstetric admissions to the labour ward and this consisted of 60 antenatal, 30 intrapartum, and two postpartum cases. The most common reason for transfer was gestational hypertension followed by labour pain. Multiple reasons led to 25% of referrals. Sixteen patients (17%) arrived without any accompanying medical personnel and 10 patients (11%) used their own transport. Duration from referral to arrival ranged from 25 minutes to 72 hours. Twenty-one patients (23%) and 18 (19%) arrived without any investigation or medications and without referral letters respectively. The mean hospital stay was 3.4 days. Two cases with singleton pregnancy were referred for intrauterine foetal deaths. Another 59 were born alive. There were no early neonatal deaths. Conclusions: Our study revealed deficiencies in the transfer procedures that can be improved. Fortunately, there were no adverse outcomes during the study period. Further improvements need to be implemented to ensure effective and efficient transfers of emergency cases.