Births in patients referred from dispersed indigenous areas to a university hospital Partos en gestantes remitidas de un territorio disperso e indígena a un hospital universitario

Abstract

Introduction: within the framework of the new pilot model of care in Colombia the fourth level referral center from the department of Guainía corresponded to a university hospital located in Bogotá. Objective: to characterize pregnant women referred from Guainía with delivery care provided at Hospital de San José between June 2016 and June 2018. Methodology: case series descriptive study. Results: 29 were high-risk pregnancies, median age 24.5 years (range 15 to 40), 73% came from urban areas, 72% were cesarean deliveries, 52% preterm births, 45% multiparous mothers and there were two twin pregnancies. All referral and discharge diagnoses coincided, 55% had preeclampsia, 24% threatened preterm labor and 7% intrauterine growth restriction. Forty-five percent of neonates had low weight or extremely low weight at birth, 41% needed intensive care and 38% were admitted to the kangaroo plan.  There were no maternal or perinatal deaths. Discussion: zero mortality reflects the clinical benefits of referral. The high number of urban origin of patients may be due to registration failures and/or difficult access from dispersed areas. Conclusion: Transfer of high-risk pregnant women by air to a pre-defined high complexity institution shows clinical benefits. Prenatal care and public health actions especially for preeclampsia and low birth weight need to be optimized in the region of origin.