title: Antenatal transfer of rural women to perinatal centres. High Risk Obstetric and Perinatal Advisory Working Group.
abstract: The aim of this study was to describe antenatal transfers of rural women to perinatal centres, and among transferred women, to assess the use of selected evidence-based therapies and determine the predictors of preterm and imminent births. The clinical records of rural women antenatally transferred to perinatal centres in NSW and the ACT during 1997-1998 were reviewed. Of 453 rural antenatal transfers, 408 (90%) were emergency transfers. Increasing remoteness was associated with increased rates of antenatal transfer but not with a lower probability of giving birth. Of all transferred women, 64% delivered; 58% of preterm transfers delivered preterm and of those delivering preterm, 76% delivered within 7 days. Although the main reason for antenatal transfer was the possibility of preterm birth, women presenting with preterm contractions only were less likely to deliver preterm (OR = 0.2, 95% CI 0.1-0.4) or < or = 7 days (OR = 0.3, 95% CI 0.2-0.5) than women with any other presenting symptoms. The overall usage of effective interventions (antenatal steroids, antibiotics for PPROM and beta-mimetic tocolysis to delay birth) among antenatally transferred rural women was high, but there is room for increased uptake prior to transfer.
authors.affiliation: NSW Centre for Perinatal Health Services Research, Department of Obstetrics and Gynaecology, University of Sydney, Australia.
authors.forename: C L
authors.initials: CL
authors.lastname: Roberts
authors.forename: D
authors.initials: D
authors.lastname: Henderson-Smart
authors.forename: D A
authors.initials: DA
authors.lastname: Ellwood
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004630:Emergencies; D019317:Evidence-Based Medicine; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000628:therapy*; D006302:Health Services Research; D006801:Humans; D008507:Medically Underserved Area; D009517:New South Wales / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010500:Perinatology / Q000379:methods* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000628:therapy*; D011256:Pregnancy Outcome / Q000453:epidemiology; D018566:Pregnancy, High-Risk; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D013256:Steroids; D015149:Tocolytic Agents / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids; D015149:Tocolytic Agents