[In utero medicalized transfers: medical regulation and transport process]

Application of the perinatality plan has led to an increase in utero medicalized transfers with an emergency mobile medical service (SAMU-SMUR). Sometimes pregnancies are transferred very far from the mother's home because of the unavailability of infant care units. This work aims to analyze the reasons for this rising trend in order to improve the features of medicalization, to define contrindications for transfers (after an appropriate medical decision) and to identify the best the modes of medicalized transports.

This retrospective study concerned 167 in utero transfers performed by the Grenoble mobile emergency unit from 1998 to 2001. The rise in the number of transports involving newborn children weighing less than 1500 g and born in Grenoble maternities was also analyzed.

From 1998 to 2001, the number of in utero medicalized transfers increase twofold. Transfers were made because of threatening premature delivery. Twin pregnancy was involved in 28% of the cases; 50% of the pregnancies had not been delivery at 7 days, and 35% were referred back to the referring institution undelivered. For preterm labor, tocolysis was instituted in 74% of those cases with b-adrenergic agents, 20% with nicarpine, and only one with atosiban. Almost all the newborn children weighting less than 1000 g, as well as 85% of the babies with a 1000-1500 g birthweight, were born in level 3 centers.

The rising trend for medicalized in utero transfers, which can be observed in mobile emergency medical services since the publication of perinatality orders is undoubtedly linked with the increase of transfers for threats of premature delivery. The improvement concerning perinatal results depends on implementing better transfer practices, which would enable selecting pregnant women presenting high risks of delivering. The use of well-designed procedures and protocols is fundamental in order to limit transfer risks. Atosiban is better tolerated than ss-adrenergic agents and nicarpine, and should be considered for use as a first-line tocolytic agent in in utero transfer for preterm labor, specially for twin pregnancies. A formalized decision making protocol and use of atosiban as tocolytic agent for preterm labor, should help lower the number of medical indications for in utero transfer.