Long-distance aeromedical repatriation of women at risk for preterm labor and delivery

Pregnant women, like everyone else, travel internationally for business and pleasure. However, since preterm labor is experienced in 8-30% of all pregnancies, a significant number of women are admitted to hospitals with signs and symptoms of threatening preterm delivery while traveling abroad. Repatriation requests represent a difficult scenario for insurance and assistance companies as well as for physicians in referring and admitting hospitals. Here, we present a comprehensive literature review and an analysis of possibilities and limitations when transporting pregnant women on international, long-distance fixed-wing Air Ambulance. While no Air Ambulance environment can provide the necessary safety for mother and baby during a delivery in-flight, available data suggests that in-flight deliveries can be successfully avoided. In this review, we propose a risk based approach, taking factors such as locally available perinatal services, transport distance and routing, presence or absence of chorioamnionitis and contractions, cervical length and cervical dilatation as well as molecular markers (fFN, PAMG-1, phIGFBP-1), if locally available, into account. wing Abbreviations: CAMTS: Commission on Accreditation of Medical Transport Systems, COXII: Cyclooxygenase-2, EURAMI: European Aeromedical Institute, fFN: fetal Fibronectin, GA: Gestational Age, HFO: High Frequency Oscillation, ICU: Intensive Care Unit, iNO: inhaled Nitric Monoxide, PAMG-1: Placental alpha-microglobulin-1, phIGFBP-1: Cervical phosphorylated insuline-like growth factor binding protein-1, PROM: Premature Rupture of Membranes, RCT: Randomized Controlled Trial, RFDS: Royal Flying Doctor Service, ROM: Rupture of Membranes.