Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved?

Autor: Langston-Cox A; Menzies School of Health Research, Charles Darwin University, John Mathews Building, Casuarina, 0810, Australia. a.langstoncox@gmail.com.; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia. a.langstoncox@gmail.com.; Department of Obstetrics and Gynaecology, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia. a.langstoncox@gmail.com., Warton E; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia., Tipping N; CareFlight Top End, Darwin, Australia., Odgers HL; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia., Nightingale A; CareFlight Top End, Darwin, Australia.; Department of Emergency Medicine, Royal Darwin Hospital, Darwin, Australia., Goni S; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia., Thorn J; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia., Brown K; Menzies School of Health Research, Charles Darwin University, John Mathews Building, Casuarina, 0810, Australia.; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia., Unger HW; Menzies School of Health Research, Charles Darwin University, John Mathews Building, Casuarina, 0810, Australia. holger.unger@menzies.edu.au.; Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia. holger.unger@menzies.edu.au.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2024 Nov 30; Vol. 24 (1), pp. 804. Date of Electronic Publication: 2024 Nov 30.
DOI: 10.1186/s12884-024-07013-w
Abstrakt: Background: Suspected preterm labour (PTL) and prelabour rupture of membranes (PPROM) are common indications for aeromedical retrieval in the Top End, Northern Territory, Australia, where many women reside remotely and preterm birth (< 37 completed weeks of gestation) is common. The primary objective of this study was to determine rate of delivery during the index admission following aeromedical transfers from remote clinics to Royal Darwin Hospital for suspected PTL/PPROM.
Methods: A retrospective cohort study of aeromedical transfers for suspected PTL/PPROM from 1 January 2020 to 31 July 2022 was undertaken. Transfers were identified through CareFlight, the regional air ambulance service, and complemented with data from hospital records. Clinical and sociodemographic characteristics were compared by delivery status during the index (post-retrieval) admission using parametric and non-parametric tests and multivariable linear regression analysis.
Results: 238 women with singleton pregnancies were retrieved for suspected PPROM (n = 77, 32.4%) or PTL (n = 161, 67.6%), together accounting for 49.2% of all obstetric transfers (n = 483). Of 77 patients transferred for suspected PPROM, 47 (61.0%) had ruptured membranes confirmed on arrival, and 45 (95.7%) of them delivered during the index admission. None of the 30 women transferred for suspected PPROM with intact membranes on arrival delivered during the index admission. Of 161 patients transferred for suspected PTL, 13 (8.1%) had ruptured membranes confirmed on arrival, and 12 (92.3%) of them delivered during the index admission. Amongst women transferred for suspected PTL with intact membranes confirmed on arrival, 14.9% (22/149) delivered during the index admission. Prior to arrival, 120 women (50.4%) had a documented speculum examination, and 15 (6.3%) and 9 (3.8%) had cervicovaginal swab tests to assess their risks of a PPROM and PTL, respectively. Half of women who did not deliver during the index admission had received antenatal corticosteroids (n = 76).
Conclusions: Many aeromedical retrievals for suspected PTL/PPROM did not result in delivery during the index admission. Women retrieved for suspected PPROM with intact membranes on arrival were less likely to deliver. Upskilling remote clinic staff and better point-of-care testing may reduce retrievals and unnecessary interventions. Prospective cohort studies designed to enable accurate prediction of which cases can be safely not retrieved are required.
Trial Registration: Not applicable.
Competing Interests: Declarations. Ethical approval and consent to participate: This study was approved by the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC 2021 − 429). Informed written consent was waived by the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research. The study was conducted in accordance with the ICH guideline for Good Clinical Practice. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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