CLINICAL AND ORGANIZATIONAL EFFECTIVENESS OF AN OPTIMIZED REFERRAL MODEL FOR PREGNANT WOMEN FROM 28 WEEKS OF GESTATION USING DMED MONITORING
Abstract
Background: Timely identification of obstetric risk and risk-appropriate referral to higher levels of care are key determinants of maternal and perinatal outcomes. However, real-world practice often includes delayed detection of risk factors and a high proportion of emergency admissions. Objective: To evaluate the clinical and organizational effectiveness of an optimized referral model from 28 weeks of gestation supported by the DMED (Digital Medical Evaluation and Diagnosis) monitoring platform. Methods: A comparative analysis was performed among 624 pregnant women managed in obstetric facilities of the Samarkand region. The intervention group (n=322) was followed using an optimized pathway: risk stratification at 28 weeks, continued supervision by the planned delivery facility, and real-time digital monitoring via DMED. The control group (n=302) received standard routing. Baseline characteristics were comparable. Primary endpoints included emergency (unplanned) admissions, preterm birth (<37 weeks), perinatal loss, neonatal intensive care need, cesarean section pattern, and mean length of stay. Results: Compared with standard routing, the optimized model reduced the share of emergency admissions (34.7% vs 18.5%). Preterm birth decreased (reported as >25% vs 15.7%), perinatal loss declined (2.7% vs 1.1%), and neonatal intensive care need decreased (15.2% vs 8.7%). Emergency cesarean section was less frequent (21.8% vs 9.6%), while planned operative delivery increased (12.4% vs 18.9%). Mean hospital stay was shorter for mothers (6.4 vs 5.6 days) and newborns (7.2 vs 6.1 days). Conclusion: An optimized referral model initiated at 28 weeks and supported by DMED monitoring improves continuity of care, reduces emergency admissions, and is associated with better perinatal outcomes and more predictable resource use.