Management of obstetric complications at a small rural hospital

To determine if there is a way of identifying obstetric patients in whom complications will develop, the experience of one small hospital was reviewed. It was found that there is no satisfactory method presently available that allows a hospital to select such patients so that they can be referred to a large centre. While the scoring system designed by Goodwin, Dunne and Thomas for assessing antepartum fetal risk is fairly effective in selecting fetuses at risk, its results do not correlate well with the frequency of obstetric complications. Since in a significant proportion of obstetric patients complications develop that require emergency intervention, it is important that hospital staff maintain their ability to do safe cesarean sections and to obtain blood for transfusion quickly. Hospitals in which there are fewer than 100 deliveries per year probably do not have a sufficient caseload to maintain the ability to do safe cesarean sections; it is therefore suggested that they discontinue obstetric practice. At hospitals with a larger caseload elective cesarean sections should be done so that the ability to do emergency procedures can be maintained.