(152) Obstetric Air Transportation in the Intermountain West: An Assessment of Quality Metrics

Objective: Obstetric transport is a critical service for high risk and rural patients and is largely understudied, especially with respect to quality metrics (QM) for common transport indications. We aimed to 1) describe obstetric transportation in the Intermountain West and 2) define and assess QM adequacy among individuals transported for the most common obstetric indications - preterm prelabor rupture of membranes (PPROM), preterm labor (PTL), and preeclampsia.

Study Design: This was a prospective cohort study of obstetric transports within a single tertiary institution with a perinatal transport service. Demographic, transport, and clinical factors were collected for all obstetric transports. Based on the Society of Maternal Fetal Medicine transport checklist, we defined QMs as recommended interventions during obstetric transport specific to PPROM, PTL, and preeclampsia. A priori, we defined QM adequacy as receipt of ≥ 75% of recommended interventions per indication. We compared QM adequacy across transport indications using Chi-squared analysis.

Results: Between July 2023-June 2024, 125 obstetric transports were performed, most frequently by rotor wing (70.4%), fixed wing (26.4%), and ambulance (3.2%). Transport distance on average was 226.1 miles (SD 186.5) (Figure 1). Mean gestational age at time of transportation was 31.1 weeks (SD 5.91). Most frequent indications for transport were preeclampsia (33.6%), PTL (27.2%), PPROM (15.2%), and fetal anomalies (13.6%). Most transported patients (88%) received medications peri-transport; 76.8% of patients received either antenatal corticosteroids, magnesium, a tocolytic, or antibiotics. QM adequacy did not differ by indication for transport (p=0.265), and was most frequently met within transports for preterm labor (73.5%), followed by preeclampsia (71.4%), and PPROM (63.2%) (Figure 2).

Conclusion: Obstetric transport in the Intermountain West relies primarily on air given the large geographic catchment. QMs specific to obstetric transport were not always met, and may provide valuable quality benchmarks to identify areas for improvement.