Optimizing Outcomes in Regionalized Perinatal Care: Integrating Maternal and Neonatal Emergency Referral, Triage, and Transport

Abstract

The purpose of integrating emergency maternal referral and triage capability into a neonatal retrieval service is to improve the effectiveness of regionalized perinatal care and to ensure opportunities for in utero transfer are maximized. Evidence for the effectiveness of regionalized perinatal care is presented, emphasizing the striking difference in survival of outborn extremely preterm (EPT) infants compared with inborn EPT infants. Barriers to achieving high rates of in utero transfer are identified and strategies to address preventable factors discussed. There is evidence of variation in rates of outborn extremely preterm births. As birth in transit is a rare event, this variation suggests there are opportunities for significant improvement in areas with high rates of outborn extremely preterm births. Variation in the level of risk aversion by triaging obstetricians and transport platform providers may be a significant preventable factor in deciding if a particular high-risk pregnant woman is deemed safe to transfer. Collaboration between obstetricians triaging these referrals and their neonatal retrieval colleagues within an integrated service is proposed as a model to address such issues. The integrated perinatal emergency referral and retrieval service is a key component of a system structured to support regionalized care. We propose this service should sit below the regional entity responsible for clinical governance that provides an imprimatur to ensure timely and equitable access to perinatal services for high-risk women and their newborn infants.