Compliance to recommended intra-partum management protocols of high-risk pregnancies among mothers in the Sunderbans: A mixed method study.

Background: During the intra-partum period, high-risk pregnancies are particularly susceptible, and without proper management, they can escalate into maternal deaths or severe complications known as maternal near-misses. Despite the availability of various national guidelines aimed at managing these high-risk situations, adherence to these protocols is notably low among mothers with high-risk intra-partum conditions. Objectives: This study aims to evaluate the compliance with recommended guidelines when referring high-risk pregnancies during labour, particularly in the challenging regions of the Sunderbans. Methods: A cross-sectional, descriptive epidemiological study with convergent parallel approach of mixed method design was conducted at the Diamond Harbour Government Medical College Hospital's labour ward. Results: The most prevalent condition among high-risk intra-partum cases was pregnancy-induced hypertension (22%), followed by anaemia (13%). While referral linkages were established for most patients (77.7%), over half (52.1%) did not receive any pre-referral treatment. Multivariate analysis revealed that mothers older than 35 years (AOR 2.28), those with a poor obstetric history (AOR 3.07), and those who were not seen by doctors (AOR 5.02) were more likely to miss out on pre-referral treatments. The study identified several key reasons for these gaps, including lack of unavailability of trained manpower, poor health communications, lack of specialised service availability and motivational issues of health care workers. Conclusions: Most instances where standard treatment guidelines were not followed can be traced back to issues within health service delivery. These issues could potentially be rectified with targeted structural and administrative interventions.