title: Aeromedical transfer of women at risk of preterm delivery in remote and rural Western Australia: why are there no births in flight?
abstract: OBJECTIVE
  For more than three decades, women at imminent risk of preterm birth (PTB) in Western Australia have been transferred by small aircraft over long distances to the single tertiary level perinatal centre in Perth, with no known case of birth during the flight. We aimed to review recent experience to understand how aircraft travel may delay PTB.
  
  
  METHODS
  Retrospective observational study of 500 consecutive Royal Flying Doctor Service (RFDS) transfers of women at risk of preterm labour to the tertiary referral centre, from September 2007 to December 31, 2009.
  
  
  METHODS
  In-flight delivery, complications associated with transfer and factors associated with delay in preterm delivery.
  
  
  RESULTS
  There were no in-flight deliveries or serious complications associated with the aeromedical transfer of these patients. In a multivariable Cox proportional hazards regression analysis, clinical factors in the presentation that were associated with a shorter time from landing to subsequent delivery included cervical dilatation ≥ 4 cm, ruptured membranes, gestational age > 32 weeks and nulliparity. The aircraft reaching an ambient altitude > 14,000 feet, or cabin altitude above zero (sea level), was associated with a delay in time from landing to delivery for women who were not in spontaneous preterm labour.
  
  
  CONCLUSIONS
  Our findings add to a 30-year experience that women at risk of preterm labour do not deliver during aeromedical transfer. Ambient and cabin altitude of the aircraft were associated with an extension in the time to delivery after arrival. The mechanisms underpinning this effect warrant further investigation.
authors.affiliation: School of Women's and Infants' Health, King Edward Memorial Hospital, University of Western Australia, Subiaco, WA 6008, Australia.. akl.natalie@gmail.com
authors.forename: Natalie
authors.initials: N
authors.lastname: Akl
authors.forename: Edwina A
authors.initials: EA
authors.lastname: Coghlan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Nathan
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Langford
authors.forename: John P
authors.initials: JP
authors.lastname: Newnham
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000399:Air Pressure; D000531:Altitude; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D053208:Kaplan-Meier Estimate; D007747:Labor Stage, First; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012424:Rural Population; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D014904:Western Australia