High-risk pregnancies (HRPs) pose a major global health challenge, contributing significantly to maternal and neonatal morbidity and mortality, particularly in low- and middle-income countries. This narrative review synthesises existing evidence on the identification and management of high-risk obstetric conditions, with a focus on the role of prompt referral in improving pregnancy outcomes. HRPs, often resulting from pre-existing conditions such as hypertension, diabetes, and anaemia, or pregnancy-induced complications like preeclampsia and obstructed labour, affect an estimated 20 million women annually. Without timely detection and intervention, these conditions lead to severe consequences including haemorrhage, sepsis, foetal growth restriction, stillbirth, and maternal death. The findings highlight that early identification of HRPs during antenatal care, coupled with efficient referral pathways, is critical in reducing adverse outcomes. However, referral systems in many resource-constrained settings remain weak, hindered by communication breakdowns, poor transportation, delays in decision-making, and socio-cultural resistance. The application of models such as the “Three Delays Framework” demonstrates how systemic inefficiencies exacerbate risks. Evidence further indicates that technology, including mobile-based communication tools, can enhance referral efficiency, though sustainable improvements require investments in infrastructure, training, and community education. Strengthening referral systems ensures timely access to emergency obstetric care (EmOC), thereby reducing preventable maternal and neonatal deaths. The review concludes that a multi-level approach integrating skilled healthcare provision, community engagement, policy support, and digital innovations is essential to advance safe motherhood. Effective referral networks remain a cornerstone strategy for achieving global targets in maternal and child health.

Keywords: High-risk pregnancy, Prompt referral, Maternal health, Pregnancy outcomes, Obstetric care,

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