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

Abstract

AbstractIntroductionThe aim of this study was to describe the characteristics and outcomes of remote-dwelling pregnant people with threatened labour referred for aeromedical retrieval to a regional birthing centre, as well as factors associated with birth within 48 hours.MethodsThis was a retrospective observational study of all pregnant people in the remote Central Australian region referred to the Medical Retrieval Consultation and Coordination Centre for labour >23 weeks gestation, between 12 February 2018 – 12 February 2020. Data was extracted manually from written medical records on maternal, neonatal and retrieval mission characteristics. Univariate and multivariate statistical analysis was performed.ResultsThere were 116 people referred for retrieval for labour. There were no births during transport and less than half of the cases in this cohort resulted in birth within 48 hours of retrieval. Tocolysis was frequently used. Predictors of birth with 48 hours were cervical dilatation 5cm or more, preterm gestational age and ruptured membranes in the univariate analysis. Nearly one-third of this cohort required intervention or had complications during birth.DiscussionBirth during transport for threatened labour did not occur in this cohort, and more than half of retrievals did not result in birth within 48 hours, however the high risk of birth complications may offset any benefit of avoiding aeromedical transport from remote regions. Retrieval clinicians should have a lower threshold for urgent transfer in cases of ruptured membranes, cervical dilatation of 5cm or more, or gestational age is less than 37 weeks.