OBSTETRICAL REFERRALS BY TRADITIONAL BIRTH ATTENDANTS
Abstract
Background: In Pakistan 90% of births are conducted by TBA's. In most cases, TBA's are unable todiagnose the complications and are often unable to take decisions on timely referral. The objective of
this study was to determine the prevalence, nature and outcome of life threatening obstetrical
conditions in referrals by Traditional Birth Attendants (TBAs). Methods: This Observational,
Descriptive study was conducted from January to December 2007, in the obstetrical unit of Fatima
Hospital, Baqai Medical University, a tertiary care community based hospital. The study included
patients referred by TBA's who developed life threatening obstetric conditions (LTOCs). Results:
Total 64 patients were referred by TBA's. The prevalence was 7.8%. Out of them, 53 (82.8%)
patients admitted with life threatening obstetric conditions. The near-miss morbidities and
mortalities were 45 (84.9%) and 8 (15%) respectively. Maternal mortality to Near-miss morbidity
ratio was 1:6. Obstructed labour caused near-miss morbidity in 32 (60.3%) patients with no
mortality. Postpartum haemorrhage as life threatening condition developed in 16 (30.1%) patients
with 10 (18.8%) near-miss morbidities and 6 (11.3%) mortalities. Puerperal sepsis accounted for 1
(1.88%) near-miss morbidity and 2 (3.76%) mortalities. The mortality index for puerperal sepsis is
(66.6%) almost double of postpartum haemorrhage (37.5%). Conclusion: Mortality to near miss
morbidity ratio is high. Misidentification and late referrals of complicated cases by TBA's were
responsible for near-miss morbidities and mortalities.
Keywords: Traditional Birth Attendants, Life threatening obstetric conditions, Maternal mortality
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