| 1 |
Author(s):
Ruvelinda Grace Uy, Norvie T. Jalani.
Page No : 1-18
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Referral Appropriateness and Structural Barriers in Basic Emergency Obstetric and Newborn Care Implementation: Evidence from Zamboanga City Medical Center, Zamboanga Peninsula, Philippines
Abstract
Background. The Basic Emergency Obstetric and Newborn Care (BEMONC) program equips lower-level facilities to manage uncomplicated deliveries and stabilize obstetric emergencies, reducing unnecessary transfers to tertiary hospitals. Despite sustained training coverage in the Philippines, tertiary facilities continue to absorb high obstetric referral volumes. This study determined the prevalence, clinical profile, institutional sources, and structural determinants of non-indicated and potentially avoidable obstetric referrals received by a tertiary government hospital in Southwestern Mindanao from February 2024 to April 2025.
Methods. A retrospective cross-sectional chart review examined 300 consecutive obstetric referral records from the Department of Obstetrics and Gynecology Referral Census. Non-indicated referrals were defined as uncomplicated normal spontaneous vaginal deliveries without a documented tertiary-level indication. A broader potentially avoidable category captured uncomplicated vaginal deliveries transferred for weak, non-medical, or capacity-related reasons. Referring facilities were cross-referenced against the institutional BEMONC training registry. Descriptive statistics, exploratory odds ratios, and sensitivity analyses were performed.
Results. Of 300 referrals, 27 (9.0%) were strictly non-indicated and 35 (11.7%) were potentially avoidable. Cesarean section accounted for 40.7% of outcomes. Generic escalation (42.7%), absence of an obstetrician (18.0%), lack of incubator/neonatal support (17.0%), and absence of an anesthesiologist (15.7%) accounted for 93.4% of referral reasons. Primary care facilities had higher odds of avoidable referral than hospital-level facilities (OR 7.26, 95% CI 2.91–18.10). Training volume showed no significant correlation with referral appropriateness (Spearman's rho = 0.02, p = .94), and facility training status was not significantly associated with avoidable referral after adjusting for facility level (OR 2.47, 95% CI 0.51–11.89).
Conclusion and Implications. Strictly non-indicated referrals were uncommon. Avoidable transfers reflected structural resource limitations rather than poor clinical judgment. These findings suggest BEMONC training alone is unlikely to reduce avoidable obstetric referrals unless matched by personnel, equipment, and referral governance. Program evaluation should incorporate facility-level referral performance alongside training coverage.
Keywords: BEMONC, maternal health, obstetric referral, referral appropriateness, structural barriers
| 2 |
Author(s):
Annie Laine Luat.
Page No : 19-50
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Assessing Sagittal Jaw Disproportion Using New Tau Angle Analysis
Abstract
Accurate assessment of sagittal jaw relationships is fundamental to orthodontic diagnosis and treatment planning; however, no single cephalometric parameter can completely describe the complexity of skeletal jaw disproportion. Although the ANB angle remains the gold standard, its accuracy may be affected by growth, jaw rotation, and anatomical variations. This study investigated the relationship between the conventional ANB angle and the novel Tau angle in assessing sagittal jaw disproportion among Filipino patients with skeletal Class I, II, and III malocclusions. Methods. This descriptive-correlational study included 80 lateral cephalometric radiographs of Filipino male and female patients with skeletal Class I, II, and III malocclusions obtained from a dental clinic in Quezon City, Philippines. Each radiograph was analyzed using both the conventional ANB angle and the novel Tau angle. Interpretations were based on established Filipino and Asian normative values, and all landmark identification, tracing, and interpretations were validated independently by three certified orthodontists. Statistical analyses were performed to determine differences according to age and sex and to evaluate the relationship between the two cephalometric analyses using Kendall's Tau-b correlation. Results. No significant differences in sagittal jaw disproportion were observed across age groups or between males and females using either the ANB or Tau angle analyses, indicating that age and sex did not influence skeletal classification. A strong positive correlation was found between the ANB and Tau angle analyses (Kendall's Tau-b = 0.79, p < 0.01), demonstrating comparable reliability in classifying sagittal jaw relationships. Conclusion. The Tau angle showed comparable reliability to the conventional ANB angle in classifying sagittal jaw disproportion and may serve as a dependable alternative when ANB landmarks are obscured or difficult to identify. These findings support the incorporation of the Tau angle into routine orthodontic diagnosis, education, and artificial intelligence-assisted cephalometric analysis, while further studies are recommended to establish normative Tau angle values for the Filipino population.
Keywords: ANB Angle, cephalometric analysis, orthodontic diagnosis, sagittal jaw disproportion, skeletal malocclusion, Tau angle, ANB angle
| 3 |
Author(s):
Jennifer D. Araneta, Norvie T. Jalani.
Page No : 51-67
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Grand Multiparity as the Dominant Correlate of Non-Institutional Delivery Among Women Discharged in Latent Labor at a Philippine Tertiary Hospital
Abstract
Non-institutional delivery remains a preventable source of maternal and neonatal morbidity in the Philippines. Grand multiparity accelerates labor progression and is a recognized risk factor for delivery outside healthcare facilities. The labor-pattern correlates of non-institutional delivery at a Philippine tertiary emergency department have not been systematically characterized.
Methods. A cross-sectional analytical study was conducted at Zamboanga City Medical Center (ZCMC), a Department of Health-retained tertiary government hospital in Zamboanga City, Philippines, from January 1, 2023, to December 31, 2024, using emergency room (ER) records and structured telephone interviews. Eligible participants were pregnant women discharged during the latent phase of labor who subsequently delivered outside the facility. The primary outcome was non-institutional delivery. Bivariate associations were assessed using Fisher's exact test, with odds ratios (OR) and 95% confidence intervals (CI). This report follows the STROBE guideline for cross-sectional studies.
Results. Of 1,336 classified records, 41 (3.1%) were non-institutional deliveries. Grand multiparity was significantly associated with increased odds of non-institutional delivery (OR 3.76, 95% CI 1.41–10.03; p = 0.018), while nulliparity was associated with reduced odds (OR 0.36, 95% CI 0.17–0.74; p = 0.004). Maternal age of 35 years or older (OR 1.16; p = 0.796) and advanced cervical dilation at discharge (OR 0.35; p = 0.317) were not significantly associated with non-institutional delivery. Mean age of women with non-institutional delivery was 26.1 ± 7.3 years, and teenagers comprised 19.5% of this group.
Conclusion and Implications. Parity, not maternal age or cervical dilation at discharge, was the primary correlate of non-institutional delivery in this setting. These findings support consideration of parity-stratified triage protocols, investment in ER labor documentation, and community-level rapid labor recognition programs targeting grand multiparous women, pending confirmation in larger, multivariable-adjusted, multi-center studies.
