A Guide to Obstetric Risk Assessment and Referral Cascade in the Primary and Secondary Healthcare Settings in Nigeria

Abstract

Obstetric risk assessment and referral cascade are two interdependent and indispensable aspects of obstetric practice used to identify high risk pregnancies with subsequent referral to a higher level of care. The aim of the study was to formulate a practice guideline for obstetric risk assessment and referral cascade from primary and secondary healthcare settings to tertiary care facilities for specialised care. It was of mixed design – observational descriptive and a systematic review carried out at the Rivers State University Teaching Hospital (RSUTH). Four groups of obstetric risk factors on which obstetric referral cascade depend were clearly defined, namely intra-partum risk factors necessitating referral to tertiary centres, medical conditions indicating increased risk suggesting antenatal care and planned birth in tertiary centres, factors and medical conditions indicating increased risk suggesting referral for booking and planned delivery in tertiary centres but for joint antenatal care at all settings of obstetric care and lastly, risk factors with known timing of occurrence and outcome necessitating referral to tertiary centres when complications occur. The urgent need for structured retraining of obstetric Practitioners and equipping primary and secondary healthcare facilities with medical instruments was also emphasised. In conclusion, four obstetric risk groups necessitating referral to tertiary health facilities were identified and the need for structured retraining of antenatal/birth Attendants and adequate equipment of healthcare facilities was highlighted.