The third delay: understanding waiting time for obstetric referrals at a large regional hospital in Ghana

Goodman, David M.; Srofenyoh, Emmanuel K.; Olufolabi, Adeyemi J.; Kim, Sung Min; Owen, Medge D.

doi:10.1186/s12884-017-1407-4

BMC Pregnancy and Childbirth

Table 2 Indications for referral

From: The third delay: understanding waiting time for obstetric referrals at a large regional hospital in Ghana

Indication	Number	Percent (%)
Fetal-pelvic size disproportion^a	346	24.3
Hypertensive disorders of pregnancy^b	139	9.8
Prior uterine scar^c	129	9.1
Maternal miscellaneous^d	115	8.1
Anemia^e	103	7.2
Self-referral/Ridge Hospital patient	92	6.5
Fetal compromise^f	69	4.8
Fetal malpresentation^g	62	4.4
Rupture of membranes^h	54	3.8
Labour	45	3.2
Lack of resources at referral siteⁱ	43	3.0
Infectious causes^j	39	2.7
Acute haemorrhage^k	39	2.7
Prematurity^l	29	2.0
Previous poor obstetric outcome^m	27	1.9
Multiple gestationⁿ	26	1.8
Record illegible	22	1.5
Maternal age extremes (≤15 or >35 yr)	18	1.3
Intra-uterine fetal demise	14	1.0
No/poor prenatal care	12	0.8
Fetal miscellaneous^o	2	0.1
Total	1425	100%
One referral indication	739	68.3%
Two referral indications	315	29.1%
Three referral indications	28	2.6%

There were 1082 referral records captured for deliveries occurring at Ridge Regional Hospital from September 9, 2012 to November 11, 2012
^aCephalopelvic disproportion, fetal macrosomia, large maternal abdomen, post-term pregnancy, over 40 weeks estimated gestational age, borderline pelvis, contracted pelvis, failure to progress (delayed or prolonged labour, arrest of labour, slow progress, failed induction, unfavorable cervix, high head in labour, obstructed labour)
^bChronic hypertension, PIH, pre-eclampsia, severe pre-eclampsia, or eclampsia
^cPrevious cesarean delivery, prior myomectomy, or previous uterine rupture
^dMaternal asthma, diabetes, gestational diabetes, prior abdominal surgery, uterine fibroids, vaginal/vulvar growth or discharge, proteinuria, urinary tract infection, fever, generalized edema, short/long pregnancy interval, short maternal stature, maternal distress, sterilization request, grand multiparty, seizure disorder, mental illness, obesity, patient refusal for care, patient lacks labouratory or scan information, crippled, rhesus negative
^eMaternal anemia or sickle cell disease
^fAbnormal cardiotocography, fetal tachycardia, fetal distress, oligohydramnios, meconium stained amniotic fluid, decreased fetal movement, intrauterine growth restricition, umbilical cord prolapse
^gFace/mentoposterior, brow, breech/footling breech, oblique, transverse, unstable lie, arm prolapse, leading twin breech, compound presentation
^hRupture of membranes, prolonged rupture of membranes, loosing liquor, gestations >37 weeks
ⁱNo electricity, no bed, no gloves, no water, no doctor, no anesthetist
^jHepatitis B, malaria, syphilis, human immunodeficiency virus
^kPlacenta previa, placental abruption, placenta accreta, ante-, intra- and postpartum bleeding, unclassified haemorrhage
^lGestation <37 weeks, prematurity, preterm labour or preterm premature rupture of membranes
^mBad obstetric history, prior stillbirth, prior ectopic pregnancy, unexplained history of intrauterine fetal death, previous failure to progress, prior cervical cerclage, previous peripartum haemorrhage
ⁿTwin pregnancy, triplet pregnancy
^oAnencephaly, severe hydrocephalus, polyhydramnios, fetal deformity

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ISSN: 1471-2393

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