Table 2

Reason for referral by phase

ReasonPhase 1Phase 3Phase 4Phase 5
Dates of collection9 September 2012–11 November 201215 September 2015–19 November 20151 December 2016–28 February 20171 September–
31 October 2017
Number of hospital deliveries1351146515891008
Fetal pelvic disproportion*346 (24.3)193 (21.0)276 (24.3)181 (26.4)
Hypertensive disorder†139 (9.8)77 (8.4)91 (8.0)86 (12.6)
Prior uterine scar‡129 (9.1)54 (5.9)114 (10.0)80 (11.7)
Maternal miscellaneous§115 (8.1)60 (6.5)100 (8.9)53 (7.7)
Anemia¶103 (7.2)40 (4.4)64 (5.7)38 (5.5)
Self-referral/no indication92 (6.5)205 (22.3)29 (2.6)42 (6.1)
Fetal distress**69 (4.8)47 (5.1)49 (4.3)37 (5.4)
Fetal malpresentation††62 (4.4)44 (4.8)65 (5.7)24 (3.5)
Rupture of membranes‡‡54 (3.8)42 (4.6)44 (3.9)21 (3.1)
Labour45 (3.2)30 (3.3)71 (6.2)36 (5.3)
Lack of resources§§43 (3.0)14 (1.5)17 (1.5)7 (1.0)
Infectious causes¶¶39 (2.7)2 (0.2)12 (1.1)3 (0.4)
Obstetric hemorrhage***39 (2.7)9 (1.0)33 (3.9)12 (1.8)
Prematurity†††29 (2.0)29 (3.2)67 (5.9)25 (3.6)
Poor obstetric history‡‡‡27 (1.9)20 (2.2)11 (1.0)4 (0.6)
Multiple gestation§§§26 (1.8)14 (1.5)28 (2.5)11 (1.6)
Record illegible22 (1.5)4 (0.4)6 (0.5)0 (0)
Age <16 or >3518 (1.3)8 (1.0)21 (1.8)5 (0.7)
Fetal demise14 (1.0)7 (1.0)16 (1.4)3 (0.4)
Poor/non-attendant12 (0.8)5 (0.5)3 (0.3)0 (0)
Fetal miscellaneous¶¶¶2 (0.1)0 (0)19 (1.7)4 (0.6)
Uterine rupture0 (0)1 (0.1)0 (0)2 (0.3)
Total1425(100)946(100)1136(100)685(100)
One referral indication739 (68.3)782 (82.7)897 (80.0)551 (80.3)
Two referral indications315 (29.1)152 (16.0)207 (18.2)134 (19.6)
Three referral indications28 (2.6)12 (1.3)32 (2.8)3 (0.4)
  • Data are shown as number (%) of responses for each reason referred.

  • Phase 1 included 1082 patients evaluated from 9 September to 11 November 2012.8

  • Phase 3 included 784 patients evaluated from 15 September to 19 November 2015.

  • Phase 4 included 901 patients evaluated from 1 December 2016 to 28 February 2017.

  • Phase 5 included 552 patients evaluated from 1 September to 31 October 2017.

  • *Cephalopelvic 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, unfavourable cervix, high head in labour, obstructed labour).

  • †Chronic hypertension, pregnancy-induced hypertension, pre-eclampsia, severe pre-eclampsia or eclampsia.

  • ‡Previous  caesarean delivery, prior myomectomy or previous uterine rupture.

  • §Maternal asthma, diabetes, gestational diabetes, prior abdominal surgery, uterine fibroids, vaginal/vulvar growth or discharge, proteinuria, urinary tract infection, fever, generalised oedema, short/long pregnancy interval, short maternal stature, maternal distress, sterilisation request, grand multiparty, seizure disorder, mental illness, obesity, patient refusal for care, patient lacks laboratory or scan information, crippled, rhesus negative.

  • ¶Maternal anaemia or sickle cell disease.

  • **Abnormal cardiotocography, fetal tachycardia, fetal distress, oligohydramnios, meconium stained amniotic fluid, decreased fetal movement, intrauterine growth restricition, umbilical cord prolapse.

  • ††Face/mentum posterior, brow, breech/footling breech, oblique, transverse, unstable lie, arm prolapse, leading twin breech, compound presentation.

  • ‡‡Rupture of membranes, prolonged rupture of membranes, losing liquor, gestations >37 weeks.

  • §§No electricity, no bed, no gloves, no water, no doctor, no anaesthetist.

  • ¶¶Hepatitis B, malaria, syphilis, HIV.

  • ***Placenta previa, placental abruption, placenta accreta, antepartum, intrapartum and postpartum bleeding, unclassified haemorrhage.

  • †††Gestation <37 weeks, prematurity, preterm labour or preterm premature rupture of membranes.

  • ‡‡‡Bad obstetric history, prior stillbirth, prior ectopic pregnancy, unexplained history of intrauterine fetal death, previous failure to progress, prior cervical cerclage, previous peripartum haemorrhage.

  • §§§Twin pregnancy, triplet pregnancy.

  • ¶¶¶Anencephaly, severe hydrocephalus, polyhydramnios, fetal deformity.