Reversing the trend: The critical need for in-utero transfer to optimise preterm outcomes in tropical LMICs

There is an inherent structural paradox faced by low- and middle-income countries (LMICs) when it comes to the field of maternal and child health. Whereas there has been success in providing basic obstetric care in the form of healthcare services in peripheral locations, modern neonatal and preterm birth care are concentrated in tertiary urban settings. Thus, high-risk pregnancies are delivered in peripheral clinics, but the fragile preterm neonates are brought to higher centres only after efforts to stabilise their clinical condition fail and severe physiological deterioration occurs. These ‘outborn’ infants present in critically ill condition, leading to unnecessary mortality and morbidity. This suggests a serious need for the implementation of pro-active rather than reactive transport through anticipated in-utero transfer. The uterus of the mother then acts as an ideal physiological transport incubator.