Outcome of high-risk pregnancies and efficiency of referral in network system

To assess the outcome of high-risk pregnancies as an indicator for the referral in the network system, a retrospective, descriptive study was conducted by reviewing the records of 206 pregnant women who were referred by primary health workers (Behvarzes) of 10 different villages in Kerman to more advanced centers during the years 1990-1995. In addition to reviewing the records, the subjects were interviewed when necessary. The most common reasons for referral were edema, hypertension, history of abortion, and previous neonatal death, inappropriate weight gain of the mother and vaginal bleeding. Among the referrals, preterm delivery rate was 9%. There were 7 cases of stillbirth and 9 cases of neonatal death. Therefore, the neonatal mortality rate and perinatal mortality rate were 43.7 and 77.7% 100 live birth respectively. In 90% of case, behvarz followed the protocols to refer the patients but only 29% of the cases followed the referral path correctly and the remaining 71% went directly to the urban centers. In 1.5% of cases the referral forms were returned to the health houses from rural health centers but none from urban centers. It is concluded that firstly, the high-risk pregnancy was over-diagnosed by behvarz and secondly, the referral does not go the right way in the network system and it needs lot of efforts to be improved