Obstetric outcomes of women referred for delivery to a tertiary hospital in northern Tanzania– a descriptive retrospective study based on a hospital birth registry

Abstract Background: Maternal mortality remains a great challenge in a low-income country like Tanzania, despite global and national efforts to improve women’s reproductive health. Timeliness and appropriateness of referral from a lower- to higher-level health facility comprise an important factor for the obstetrics outcome for pregnant women. This study aimed to determine the obstetric outcomes, such as maternal deaths, of women referred to KCMC, a tertiary hospital in northern Tanzania. Methods: A descriptive retrospective study based on a hospital birth registry was conducted, using consecutive stored data on pregnant women referred while in labor and managed at the KCMC tertiary hospital in northern Tanzania between the years 2000 and 2015. All referred pregnant women whose labor status information was missing during admission were excluded from the study. Results: During the study period, a total of 53662 deliveries were managed at KCMC. Among these, 6066 women were referred from lower health facilities, with 4193 (69.2%) of them being referred while in labor. The main reason for referral was poor progress of labor (31.0%), followed by prolonged labor (27.1%) and obstructed labor (19.5%). For 1859 (44.6%) women, delivery was by caesarean section. A total of 292 maternal deaths occurred between 2000 and 2015. Of these, almost a quarter (22.6%) occurred in women referred from other health facilities while in labor. Conclusions: Most of the maternal complications during labor and delivery were prevalent among women referred from lower health facilities. This underscores the need to strengthen lower health facilities’ ability to detect complications in timely manner and provide effective emergency obstetric care, as well as to refer women to higher-level facility.