ABSTRACT
Background: 22% of the population are constituted by women of child bearing age of 15-45 years in India. They are a vulnerable risk group which is due to pregnancy and child bearing. For providing access to essential obstetric care, the referral system is an essential component of any health systems which are important in pregnancy and child birth. Aim: This study was done to review the pattern of obstetric cases referred and to identify the clinical course, mode of management, maternal and perinatal outcomes. Materials and methods: This prospective observational study reviewed 100 obstetric cases. Thorough history was taken; complete physical and obstetric examination and relevant investigations were done. Management of the patient, clinical course, mode of delivery, both maternal and perinatal outcomes were documented. Results: Most common diagnosis at referral was medical disorders complicating pregnancy (45%) among which hypertensive disorders accounted for 34%, followed by severe anemia (17%). Twentyone percent of the patients were in serious or critical condition on arrival, 29% patients required surgical intervention, 19% received intensive care management and there were no mortalities. Total number of live births were 73 (78.5%) among which 28 (30%) required neonatal admission and 5 (5.3%) had early neonatal death. Vaginal delivery rate was 78% in spite of high risk conditions and various complications. Only 30% had the required three visits and 18% had a delay ranging from 3hrs to 18 hours to reach the referral centre. Conclusion: Most common diagnosis at the time of referral was hypertensive disorders of pregnancy and its various presentations like eclampsia, HELLP, DIC, Abruption. There is still scope for Devineni K, Sodumu N. A study of spectrum of referral pattern at a tertiary teaching hospital towards better obstetric care. IAIM, 2016; 3(8): 193-198. Page 194 improving antenatal care, reduce 1st delay, 2 nd delay and need to strengthen FRU and emergency obstetric care centres at some of the districts.
ABSTRACT
Recientes avances logrados en el diagnóstico, manejo clínico y terapéutico de la hipertensión pulmonar (HP) han resultado en una mejoría significativa de la sobrevida de los pacientes que padecen esta enfermedad. La complejidad de la HP, particularmente en sus variantes hipertensión arterial pulmonar (HAP) e hipertensión pulmonar por enfermedad tromboembólica crónica (HPTEC), requiere el abordaje de un equipo multidisciplinario especializado en el tema, con experiencia en diagnóstico, seguimiento y opciones terapéuticas de la misma. Las sociedades científicas internacionales recomiendan la creación de centros de referencia en hipertensión pulmonar (CRHP) definidos como "una unidad asistencial que se caracteriza por su competencia específica en la atención de personas con HP, para lo cual cuenta con la infraestructura necesaria y recursos humanos de alta especialización". Criterios de derivación de pacientes al CRHP son, entre otros, una presión sistólica de arteria pulmonar estimada superior a 50 mmHg, sospecha de HPTEC, y pacientes con tratamiento apropiado para HP que no evolucionan adecuadamente. La unidad debe disponer de recursos humanos calificados, infraestructura adecuada para diagnóstico específico, incluyendo el servicio de hemodinamia con realización de cateterismo derecho y prueba aguda de vasoreactividad pulmonar. De no disponer la Institución de capacidad para cirugía de tromboendarterectomía pulmonar, trasplante pulmonar o cardio-pulmonar, debería proveer los medios necesarios para una pronta derivación a centros que aporten dichas prestaciones cuando sean requeridas.
Major advances in diagnosis, clinical management and therapeutic strategies led to a significant survival increase for patients with pulmonary hypertension (PH). Disease complexity, specially pulmonary arterial hypertension (PAH) and that related to chronic thromboembolic disease (CTEPH), requires a multidisciplinary approach. International scientific associations recommend the organization of specifically trained, skilled medical teams, acting as "Referral Centers". These units may combine both the highest qualified human resources and up-dated technical background to provide the best medical assistance for these patients. Main criteria for patients referral should be: an estimated systolic pressure over 50 mmHg, suspicion of chronic pulmonary thromboembolism and treatment failures in known hypertensive patients. In addition to a high qualified personnel, the center should allow accessibility to a hemodynamic laboratory for catheterization procedures, including pulmonary vasoreactive tests. Moreover, in cases that thromboendarterectomy or pulmonary transplantation are not available at site, prompt referral to a more complex should be immediately provided.