893: Levels of maternal care and indications for transport

Abstract

OBJECTIVE: Rates of maternal morbidity in the US are accelerating partly due to increasing comorbidities among pregnant women. Proposals to adopt levels of maternal care (LOMC), similar to neonatal care, would direct patients to riskappropriate care earlier in pregnancy, theoretically reducing maternal transports, optimizing resources, and improving outcomes. The objective of this study is to describe characteristics and indications for maternal transport by LOMC within a state transport system. STUDY DESIGN: This is a retrospective cohort study of all maternal transports from Sept '15 e Jun '19 to Johns Hopkins Hospital (JHH, one of two Level IV centers within Maryland) or JH Bayview (JHB, Level III). Data were extracted from transport logs and electronic medical records; transports for neonatal indication were excluded. Continuous variables were compared using ANOVA, categorical variables using Chi-square, and a p-value < 0.05 used for statistical significance. RESULTS: 652 transports for maternal indication were recorded. Transport indication varied significantly by LOMC (P< 0.001): hospitals with 'no L&D' most commonly transported for

Maternal Transport, What Do We Know: A Narrative Review

“…The most common indications for transport between hospitals are pregnancy-induced hypertension, infection, and placentation. 8 To measure maternal outcomes, maternal mortality review committees (MMRCs) can use transport records to comprehensively assess pregnancy-related deaths. 4 Pregnancy-related death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic events of pregnancy.…”

“…Transport delay can immensely impact maternal outcomes. 8 In a study in Jordan in 2012, 15.8% of cases of substandard maternal care were attributed to a delay in transport. 11 An improvement in the efficiency of the maternal acceptance process, and therefore decreasing time for maternal transport, will directly improve maternal and neonatal outcomes.…”

“… 11 An improvement in the efficiency of the maternal acceptance process, and therefore decreasing time for maternal transport, will directly improve maternal and neonatal outcomes. 8 …”

“…This would theoretically reduce maternal transports, optimize resources, and improve outcomes. 8 A study by Koguttet al examined 652 maternal transports from Sept ‘15–Jun ‘19 to either Johns Hopkins Hospital (a Level IV center) or JH Bayview (a Level III center). They recorded the indication for transport as well as the LOMC provided by the referring hospital.…”

“…It was determined that approximately 20% of transports were potentially preventable if care had been initiated at a risk-appropriate level of care sooner in the pregnancy. 8 …”