Development of an index of maternal transport

The authors used a decision-analytic approach to develop a Maternal Transport Index (MTI) from ACOG guidelines for maternal transport. Data were obtained from three questionnaires administered to five perinatologists, practicing in facilities with various casemixes. Each questionnaire was based on a given level of hospital and contained scenarios describing indications for maternal transport. The MTIs, ratios of the logs of the proportions with given outcomes in Level III hospitals relative to Level I (or II) hospitals, ranged from 1.0 to 26.3 for newborn outcomes. They were greater for Level I hospitals (than Level II) and when newborn outcomes included severe disability as well as death. Within gestational age categories, the MTI was generally greatest for active preterm labor and, within complication categories, for 24-26 or 27-31 weeks' gestation. It was large for maternal outcomes only for two rare acute medical conditions. The MTI has potential use in setting priorities for maternal transport.