Obstetrical patients are among referrals from District Hospitals (DHs) to Butare University Teaching Hospital(CHUB)/Obstetrics and Gynecology (OBGYN) department. Most of the time they are referred in very critical conditions. Knowing the main reasons of referrals from district hospitals and their management could help in improving patients care at the level of  both settings (CHUB and District Hospitals). A retrospective cohort study was done on 318 women in post-partum period with obstetrical or pregnancy-related complications referred  at CHUB OBGYN department over a 2 year period (September 1^st, 2012-August 31^st, 2014). The aim of this study was to determine the morbidity and mortality amongst patients referred from district hospitals to CHUB/OBGYN Department in postpartum period and focusing on reasons of transfer, their management and outcome. The data were processed using Epidata 3.1, Excel and STATA 13 software. Chi-square and linear regression were used to compare variables. In total 318 patients were referred to CHUB/OBGYN in our study period and main reasons of referrals were post-partum hemorrhage 32.38% (103/318) followed by post-C/S peritonitis with Septic shock 9.1% (29/318).DVT, post-partum anemia, superficial wound infection, endometritis, pre-eclampsia and eclampsia were among less frequent reasons of reference. Amongst patients with post-partum hemorrhage, 10.06% (32/318) of patients underwent abdominal hysterectomy. Overall 45.2% (144/318) of patients were managed surgically and 16% (51/318) patients underwent hysterectomy in their management. Case fatality rate is 6.3% (20/318) and 11.63% (37/318 patients) were discharged with complications. A linear regression established that the time spent at the district hospital prior to referral was significantly associated with poor patient outcome (P<0.01). Patients who were managed with the right diagnosis at admission had significantly less morbidity and mortality, p<0.01. Most referrals from the district hospital for patients in post-partum period were for PPH and post-C/S peritonitis with 6.3% as case fatality rate. Training of DHs staff in emergency obstetric care and in essential surgical skills, reviewing their decision making in case of C/S to be done and early referral would improve patients care at DHs.

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