title: Access to transport for women with hypovolemic shock differs according to weeks of pregnancy.
abstract: OBJECTIVE
  To examine whether women with hypovolemic shock secondary to obstetric hemorrhage are transported to referral hospitals differently depending on weeks of pregnancy in Zambia.
  
  
  METHODS
  In a retrospective study, transport type, wait time, and transit time were assessed for women with obstetric hemorrhage and hypovolemic shock transported from 26 primary health centers to three referral hospitals during 2007-2012. A mean arterial pressure of less than 60 mm Hg was used to indicate severe shock. Women were split into two categories on the basis of the number of weeks of pregnancy (<24 weeks vs ≥24 weeks).
  
  
  RESULTS
  Overall, 616 women were included. Mode of transport differed significantly by group (P<0.001). 414 (93.0%) of 445 women at 24 weeks of pregnancy or more were transported by ambulance versus 114 (66.7%) of 171 women at less than 24 weeks. Among those in severe shock, 106 (93.0%) of 114 women at 24 weeks of pregnancy or more were transported in ambulances versus 26 (52.0%) of 50 women at less than 24 weeks (P<0.001).
  
  
  CONCLUSIONS
  Women at 24 weeks of pregnancy or more were given preference for ambulance transport even when signs of shock were equivalent. Policy-makers aiming to lower maternal mortality need to address transport issues regardless of the etiology of hemorrhage or week of pregnancy.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA. Electronic address: ebutrick@globalhealth.ucsf.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Butrick
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Penn
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Itakura
authors.affiliation: Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia; Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Gricelia
authors.initials: G
authors.lastname: Mkumba
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Winter
authors.affiliation: Department of Obstetrics and Gynecology, University Teaching Hospital, Lusaka, Zambia.
authors.forename: Rhoda
authors.initials: R
authors.lastname: Amafumba
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
mesh_terms: D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008428:Maternal Mortality; D010044:Outpatient Clinics, Hospital; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011264:Pregnancy Trimesters; D012017:Referral and Consultation; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology; D014187:Transportation of Patients / Q000379:methods*; D015024:Zambia
keywords: Complications of abortion; Emergency transport; Hemorrhage; Maternal health; Millennium Development Goal 5 (MDG 5); Reproductive health