Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved?
Abstract 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 prima...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-11-01
|
| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-024-07013-w |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850064579822878720 |
|---|---|
| author | Annie Langston-Cox Emily Warton Nadine Tipping Harrison L. Odgers Adrian Nightingale Sherihan Goni Jane Thorn Kiarna Brown Holger W. Unger |
| author_facet | Annie Langston-Cox Emily Warton Nadine Tipping Harrison L. Odgers Adrian Nightingale Sherihan Goni Jane Thorn Kiarna Brown Holger W. Unger |
| author_sort | Annie Langston-Cox |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-302fc9494c814cdfa08b58f021e42206 |
| institution | DOAJ |
| issn | 1471-2393 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-302fc9494c814cdfa08b58f021e422062025-08-20T02:49:16ZengBMCBMC Pregnancy and Childbirth1471-23932024-11-012411910.1186/s12884-024-07013-wAeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved?Annie Langston-Cox0Emily Warton1Nadine Tipping2Harrison L. Odgers3Adrian Nightingale4Sherihan Goni5Jane Thorn6Kiarna Brown7Holger W. Unger8Menzies School of Health Research, Charles Darwin UniversityDepartment of Obstetrics and Gynaecology, Royal Darwin HospitalCareFlight Top EndDepartment of Obstetrics and Gynaecology, Royal Darwin HospitalCareFlight Top EndDepartment of Obstetrics and Gynaecology, Royal Darwin HospitalDepartment of Obstetrics and Gynaecology, Royal Darwin HospitalMenzies School of Health Research, Charles Darwin UniversityMenzies School of Health Research, Charles Darwin UniversityAbstract 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.https://doi.org/10.1186/s12884-024-07013-wPregnancy complicationsAir ambulancesDiagnosisMaternal health servicesPreterm labourPreterm premature rupture of membranes |
| spellingShingle | Annie Langston-Cox Emily Warton Nadine Tipping Harrison L. Odgers Adrian Nightingale Sherihan Goni Jane Thorn Kiarna Brown Holger W. Unger Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved? BMC Pregnancy and Childbirth Pregnancy complications Air ambulances Diagnosis Maternal health services Preterm labour Preterm premature rupture of membranes |
| title | Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved? |
| title_full | Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved? |
| title_fullStr | Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved? |
| title_full_unstemmed | Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved? |
| title_short | Aeromedical retrieval for suspected preterm labour or rupture of membranes in the Northern Territory, Australia: may some cases be safely not retrieved? |
| title_sort | aeromedical retrieval for suspected preterm labour or rupture of membranes in the northern territory australia may some cases be safely not retrieved |
| topic | Pregnancy complications Air ambulances Diagnosis Maternal health services Preterm labour Preterm premature rupture of membranes |
| url | https://doi.org/10.1186/s12884-024-07013-w |
| work_keys_str_mv | AT annielangstoncox aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT emilywarton aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT nadinetipping aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT harrisonlodgers aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT adriannightingale aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT sherihangoni aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT janethorn aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT kiarnabrown aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved AT holgerwunger aeromedicalretrievalforsuspectedpretermlabourorruptureofmembranesinthenorthernterritoryaustraliamaysomecasesbesafelynotretrieved |