Appropriateness of antenatal referrals to a regional perinatal center

In an ideal system, all women should receive perinatal care adequate to their needs. For specific high-risk groups, this can only be accomplished by antenatal referral to another source of care. The appropriateness of antenatal referrals for patients at risk for premature delivery (less than or equal to 34 weeks) was studied. Records of 122 women in preterm labor and/or with premature rupture of membranes (PROM) presenting to two level I rural hospitals located 60 miles from the regional perinatal center (RPC) were reviewed. Fifty-three patients were not referred and were delivered of 59 infants within 24 hours of admission. Cervical dilatation greater than or equal to 4 cm (34 patients), vaginal bleeding (6 patients), extreme prematurity (6 patients), and advanced labor (7 patients) precluded referrals. Realistically, two of these patients should have been referred. Twenty-two of the 59 infants weighed less than or equal to 1,500 g at birth, 17 weighed 1,501-2,000 g, and 20 weighed greater than or equal to 2,000 g. Five infants died in the hospital, two during the first month and three later. Twenty-two percent had Apgar scores of less than or equal to 3 at 5 minutes. Thirty-four infants were transported to a level III neonatal intensive care unit (NICU). Fourteen of the 69 antenatal referrals required hospitalization (average 11 days), were returned to their local hospital, and delivered at term. Forty-four patients were delivered within 24 hours and 11 between 1 day and 9 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)