problems of the referral system and counter-referral to the maternity ward of the Sylvanus Olympio university hospital center in Lome

Abstract

Objective: The objective of our study was to study the problem of the referral and counter-referral system at the maternity ward of the CHU Sylvanus Olympio (CHU SO) in Lomé. Methodology: This was a cross-sectional study with prospective collection from July 1 to September 30, 2020, relating to the case of women evacuated or referred for an obstetric cause to the maternity ward of the CHU SO. The data collected using a collection sheet were analyzed using Epi Info version 7 software. Results: During the study period, the frequency of referrals was 53.5%. The majority of patients were between 20 and 30 years old old and were housewives (33.0%) with a primary education level (64.0%). The reason for evacuation was dominated by emergencies during labor (36.3%). Patients in 99% were referred without a call before referral and without referral support in 20.0%. Parturients were evacuated without a partogram and were not conditioned before evacuation (93.1%). They took more than 30 minutes before leaving the referring center (49.1%). The reasons for the delay were: lack of means of transport or companion. Taxi (53%) and motorcycle (41%) were the means of transport used. They took more than an hour (51.9%) from referral to admission to CHU SO. Maternal complications were dominated by postpartum anemia (45.3%), delivery hemorrhage (22.4%) and endometritis (16.1%) with 0.8% deaths. Perinatal morbidity was 58.5% and was dominated by perinatal infection (52.1%). The stillbirth rate was 8.4%. The counter-reference had not been carried out (99%).  Conclusion: Several dysfunctions causing the failure of the reference and counter-reference system constitute factors of poor maternal-fetal prognosis of evacuees.