Time to delivery: Transfers for threatened preterm labour and prelabour rupture of membranes in Western Australia

Abstract

Objective: To describe the outcomes of patients transferred to King Edward Memorial Hospital (KEMH) with signs of labour at preterm gestations. Design: A retrospective observational study of the 69 cases transferred to KEMH during 2015. Setting: Patient transfers from all locations across Western Australia (WA) to the sole tertiary perinatal centre in Perth. Participants: Pregnant women within WA with threatened or actual preterm labour (PTL) or preterm prelabour rupture of membranes (PPROM) between 23 and 32 weeks gestation. Main outcome measures: The occurrence of delivery during the admission and time-to-delivery as well as length of admission and association between clinical factors and time-to-delivery. Results: The percentage of the study population delivered during the admission following transfer was 72.5%. Eighty-six per cent of those who delivered did so within 72 hours of transfer. The median time from transfer to delivery was 1 day. Sixty-three per cent of those who did not deliver during the admission progressed to 36 weeks gestation. Patients transferred with PPROM were less likely to deliver during the admission compared to those with uterine activity (50% versus 19.6%, P = 0.007) and nulliparas were more likely to deliver (93.5% versus 55.3%, P < 0.001). Conclusion: The majority of women transferred with signs of PTL progress to delivery during the same admission with the highest risk of delivery being the first 72 hours following transfer. If the pregnancy is ongoing at 72 hours, there is a reasonable chance of progression to late preterm gestation supporting the return of woman to their place of origin for antenatal care following discharge.

Is Appropriate Administration of Antenatal Corticosteroids Associated with Maternal Race?

“…23 Access to care may also be a factor, such as when care is sought or if the mother had to be transferred, although in our analysis the relationship persisted despite adjusting for both number of prenatal care visits and maternal transfer. 25,26 Underlying all of these factors is the concern that systemic racism and discrimination may be contributing to these disparities. 11,27 The administration of ACS to women who deliver prematurely improves neonatal outcomes including death, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, need for mechanical ventilation, and systemic infection within the first 48 hours.…”

“…23 Access to care may also be a factor, such as when care is sought or if the mother had to be transferred, although in our analysis the relationship persisted despite adjusting for both number of prenatal care visits and maternal transfer. 25 26 Underlying all of these factors is the concern that systemic racism and discrimination may be contributing to these disparities. 11 27…”

Confinement or internment? Aeromedical retrieval of pregnant people in labour: A retrospective observational study

“…Pre-hospital and retrieval medicine experts recommend that a patient with cervical dilatation greater than 5cm, should not be transferred due to the risk of precipitous birth in-flight(14). One study of rural women transferred to a tertiary hospital for signs of preterm labour showed that cervical dilatation (in conjunction with nulliparity and regular contractions) was associated with shorter time-to-birth(29). In nearly half of all cases in this cohort, no cervical examination was performed, possibly due to lack of confidence in performing the exam, or because the examination would not change the need for retrieval.…”

Temporal trends of in utero and early postnatal transfer of extremely preterm infants between 2011 and 2016: a UK population study

“…12 Careful consideration is required to determine which women can be safely transferred using midwifery and obstetric expertise, as well as better predictors of preterm delivery. 34 35 The majority of women in threatened preterm labour do not deliver within 24 hours of presentation [36][37][38] and infants rarely deliver during transportation. 34 36 39 This suggests the window of opportunity for IUT may be greater than currently perceived and improving care pathways could help reverse the declining IUT rate.…”