Menzies School of Health Research, Charles Darwin University, John Mathews Building, Casuarina, 0810, Australia.
Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Australia.
BMC Pregnancy Childbirth. 2024 Nov 30;24(1):804. doi: 10.1186/s12884-024-07013-w.
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.
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.
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).
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.
Not applicable.
在澳大利亚北部地区的达尔文市，由于许多女性居住在偏远地区，早产（<37 周妊娠）较为常见，因此疑似早产（PTL）和胎膜早破（PPROM）是航空医疗后送的常见指征。本研究的主要目的是确定从偏远诊所通过航空医疗后送至达尔文皇家医院就诊的疑似 PTL/PPROM 患者的索引入院期间的分娩率。
回顾性队列研究纳入了 2020 年 1 月 1 日至 2022 年 7 月 31 日期间因疑似 PTL/PPROM 而通过区域空中救护服务 CareFlight 进行航空医疗后送的患者。通过 CareFlight 确定转诊患者，并通过医院记录补充数据。采用参数和非参数检验以及多变量线性回归分析比较索引（检索后）入院期间分娩状态的临床和社会人口学特征。
共检索到 238 例单胎妊娠患者，其中 77 例（32.4%）为疑似 PPROM，161 例（67.6%）为疑似 PTL，这两者占所有产科转诊患者的 49.2%（n=483）。在因疑似 PPROM 而转诊的 77 例患者中，47 例（61.0%）在抵达时证实胎膜破裂，其中 45 例（95.7%）在索引入院期间分娩。在抵达时胎膜完整的 30 例疑似 PPROM 患者中，没有一人在索引入院期间分娩。在因疑似 PTL 而转诊的 161 例患者中，13 例（8.1%）在抵达时证实胎膜破裂，其中 12 例（92.3%）在索引入院期间分娩。在抵达时胎膜完整且确诊为疑似 PTL 的 149 例患者中，有 14.9%（22 例）在索引入院期间分娩。在抵达前，有 120 例患者（50.4%）接受了阴道镜检查，有 15 例（6.3%）和 9 例（3.8%）分别进行了宫颈阴道拭子检查，以评估其发生 PPROM 和 PTL 的风险。在索引入院期间未分娩的 50 例患者中，有一半（n=76）接受了产前皮质激素治疗。
许多因疑似 PTL/PPROM 而进行的航空医疗后送并未导致索引入院期间分娩。在抵达时胎膜完整的疑似 PPROM 患者中，分娩的可能性较小。对偏远诊所工作人员进行技能提升培训，并改善床边检测，可能会减少转诊和不必要的干预。需要进行前瞻性队列研究，以准确预测哪些病例可以安全地不进行转诊。
不适用。
