Indications for Transfer and Care Pathways of Inuit Transferred to a Tertiary Center for Childbirth in Quebec, Canada: A Retrospective Chart Review 2015-2019.

Abstract

Objective: Childbirth evacuation, the transfer of patients from rural and remote communities to urban centers for pregnancy care or childbirth, can be associated with numerous adverse health outcomes and contributes to widening health disparities between Inuit and non-Indigenous populations in Quebec. We examined the indications and outcomes of childbirth evacuations among Inuit from Nunavik, northern Quebec transferred to a southern tertiary care center.

Methods: A five-year retrospective chart review included 677 pregnancies of 597 Inuit with obstetric indications transferred to a tertiary care center between 2015 and 2019.

Results: The most common reasons for transfer were diabetes (70/677, 10.3%), hypertension (69/677, 10.2%), abnormal prenatal screen/soft markers (57/677, 8.4%), and threatened preterm labour (55/677, 8.1%). Of 534 (78.9%) Inuit who gave birth at the tertiary center, 84.1% (449/534) were vaginal births. Overall, 27.0% (144/534) had obstetric complications, with postpartum hemorrhage (58/534, 10.9%) and retained placenta (34, 6.37%) being the most common. Of the 549 neonates, 9 were stillbirths (1.6%), and 69 neonates (12.6%) required admission to neonatal intensive care unit. Some 3.4% (18/534) had complications within the postpartum period, the most common being retained products of conception (4/18, 22.2%) and postpartum preeclampsia (4/18, 22.2%).

Conclusion: A relatively young and multiparous population, Inuit from Nunavik have unique health profiles and care needs. Further investment in health care capacity in Nunavik, alongside locally adapted, prevention-focused perinatal health programming, might improve perinatal health profiles and reduce the rates of childbirth evacuation.