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Obstetric Quality and Safety

Poster Session 2

(604) Frequency of preterm birth after regional maternal transport for threatened preterm birth.

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Perinatal regionalization, which allows for inpatient maternal transport in the context of predicted need for a higher level of neonatal care, has been demonstrated to reduce infant morbidity and mortality. However, some maternal transports will ultimately prove unnecessary in the context of threatened preterm birth (PTB). Here, we investigate maternal characteristics of those transported for threatened PTB from community-based hospitals to our tertiary academic center. 

Study Design:

This was a retrospective cohort study of maternal transports for threatened PTB without PPROM between 21+0 and 35+6 weeks from 2019-2022. Chart review was used to collect gestational age (GA) at transport, prior obstetric history, and current pregnancy course and outcome. Fisher’s exact and t-test were used for statistical analyses, with significance set at a p- value of < 0.05.

Results:

There were 502 maternal transports to our institution from 17 different community hospitals. Of these, 215 transports were for threatened PTB and/or PPROM, of which 151 were for threatened PTB alone. The average GA of transport was 31+3 weeks, and in 83% of cases, betamethasone was initiated before transport. Table 1 demonstrates the obstetric parity of the cohort overall and stratified by whether or not delivery occurred during transport hospitalization. As shown, there were no differences in obstetric history between the two groups. Most patients did not deliver during the transport hospitalization (96/151, 65%), though 65% ultimately delivered < 37 weeks. Only 5 patients delivered within 1 week of discharge from the transport hospitalization. The cervical exam prior to transport was documented in 114 cases and was greater in those who delivered during the transport hospitalization (3.1 cm vs. 1.8 cm, p= < .001).

Conclusion: Prediction of need for acute transport for threatened PTB remains challenging regardless of prior obstetric history. While the majority of transports did not deliver during transport hospitalization, risk assessment for PTB was reasonably accurate, as 65% of the cohort ultimately delivered < 37 weeks.