preprint · medRxiv
Prompt review of very high-risk pregnant women by an obstetrician within one hour of hospital admission is critical to prevent severe maternal morbidity and death. An investigation of 454 patient files at Mbale Regional Referral Hospital in Eastern Uganda assessed how frequently this standard was met for mothers triaged in the highest risk category. Only 33.9 percent of these patients received specialist evaluation within the critical one-hour window. Multivariable analysis revealed that conducting foetal heart monitoring only once was independently associated with a significantly reduced likelihood of timely review. Other sociodemographic and obstetric factors examined showed no statistically significant link. These results indicate that emergency specialist assessment remains far below national guidelines, highlighting the need to strengthen triage workflows and specialist coverage in regional referral settings.
Delays in treating life-threatening pregnancy complications, such as haemorrhage and obstructed labour, drive high maternal mortality rates across sub-Saharan Africa. Revealing that nearly two-thirds of critically ill mothers miss timely specialist review provides hospital managers and public health authorities with clear evidence to redesign emergency triage systems, improve staffing allocation, and prevent avoidable deaths during childbirth.
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Abstract Background Timely review of very high-risk mothers by an obstetrician within one hour of admission is very important in enabling fast decision making for emergency intervention. Any delays in review of high-risk obstetric patient such as hypertensive disorders, obstructed labour or haemorrhages increase maternal morbidity and mortality. Globally, more than 260,000 mothers die from pregnancy related causes with sub-Saharan Africa being contributing 70%. To reduce this mortality, the ministry of health of Uganda encourages urgent assessment of all high-risk pregnant mothers. This study assessed the proportion and factors associated with specialist review within one hour of very high-risk obstetric mothers at Mbale Regional Referral Hospital. Methods A retrospective quantitative study was conducted from June to October 2025 at a tertiary Hospital in Easter Uganda. Systematic sampling was used to select files of mothers triaged as very high (red category). The minimum calculated sample size was 427, but 454 eligible files were analysed to improve precision. Social demographics obstetric characteristics and timing of specialist review ere extracted. Data were entered into excel and analysed using STATA. Descriptive statistics summarized proportions and modified Poisson regression identified factors associated with timely review at 95% CI and p<005. Results The proportion of very high-risk mothers reviewed within one hour was 33.9 % (95% CI:29.7%-38.4%). In multivariable analysis, foetal heart monitoring conducted once was independently associated with lower likelihood of timely review (aPR=0.575,95% CI:0.334-0.988; p=0.045). No other variables showed significant association. Conclusion Only one-third of very high-risk mothers received specialist review within one hour below national recommendations. Strengthening obstetric triage and specialist availability is essential to improving emergency obstetric care
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DOI: 10.64898/2026.08.18.26360660
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