Perinatal transport to a regional perinatal center in a metropolitan area: Maternal versus neonatal transport.

A prospective study was undertaken to evaluate antenatal maternal referral, acute maternal transport, and neonatal transport to a regional perinatal center in a metropolitan area. During an 18-month period, there were 143 antenatal maternal referrals, 254 antenatal maternal transports, and 506 neonatal transports. Indications for the antenatal referrals were maternal diseases of a chronic nature. This group had a 28.7% incidence of delivery by primary cesarean section, a 15.8% incidence of low-birth weight infants, and a 30.8% incidence of neonatal admissions to the Neonatal Intensive Care Unit (NICU). The perinatal mortality rate was 13.7 per thousand which compares favorably with that of low-risk obstetric patients. Indications for the antenatal maternal transports were mainly premature labor and/or premature rupture of the membranes and third-trimester bleeding. There was a 37% incidence of delivery by primary cesarean section and a 71.5% incidence of low-birth weight infants, and 77.4% of the newborn infants were admitted to the NICU. The perinatal mortality rate was 137.4 per thousand live births. Compared to postnatal neonatal transports, the neonates transported antenatally had a slightly higher mortality rate which was not statistically significant. One hundred thirty-one neonates transported antenatally could be matched in sequential order of admission with 131 neonates transported postnatally of comparable birth weights and gestational ages. Although there was a significant increase in the incidence of delivery by cesarean section among the mothers transported antenatally, the neonates in this group had a significantly lower incidence of respiratory distress syndrome and other morbidity and a shorter hospitalization. This study suggests that antenatal referral and transport of high-risk parturient patients to a regional perinatal center may significantly decrease neonatal morbidity and length of hospitalization.