In-utero Transfer Research Articles

The QUiPP App: a safe alternative to a treat-all strategy for threatened preterm labor.

To evaluate the impact of triaging women at risk of spontaneous preterm birth (sPTB) using the QUiPP App, which incorporates a predictive model combining history of sPTB, gestational age and quantitative measurements of fetal fibronectin, compared with a treat-all policy (advocated by the UK National Institute for Health and Care Excellence) among women with threatened preterm labor before 30 weeks' gestation. Prospectively collected data of pregnant women presenting with symptoms of preterm labor (abdominal pain or tightening) at 24-34 weeks' gestation were retrieved from the research databases of the EQUIPP and PETRA studies for subanalysis. Each episode of threatened preterm labor was retrospectively assigned a risk for sPTB within 7 days using the QUiPP App. A primary outcome of delivery within 7 days was used to model the performance accuracy of the QUiPP App compared with a treat-all policy. Using a 5% risk of delivery within 7 days according to the QUiPP App as the threshold for intervention, 9/9 women who presented with threatened preterm labor < 34 weeks would have been treated correctly, giving a sensitivity of 100% (one-sided 97.5% CI, 66.4%) and a negative predictive value of 100% (97.5% CI, 98.9-100%). The positive predictive value for delivery within 7 days was 30.0% (95% CI, 11.9-54.3%) for women presenting before 30 weeks and 20.0% (95% CI, 12.7-30.1%) for women presenting between 30 + 0 and 34 + 0 weeks. If this 5% threshold had been used to triage women presenting between 24 + 0 and 29 + 6 weeks, 89.4% (n = 168) of admissions could have been safely avoided, compared with 0% for a treat-all strategy. No true case of preterm labor would have been missed, as no woman who was assigned a risk of < 10% delivered within 7 days. For women with threatened preterm labor, the QUiPP App can accurately guide management at risk thresholds for sPTB of 1%, 5% and 10%, allowing outpatient management in the vast majority of cases. A treat-all approach would not have avoided admission for any woman, and would have exposed 188 mothers and their babies to unnecessary hospitalization and steroid administration and increased the burden on network and transport services owing to unnecessary in-utero transfers. Prediction of sPTB should be performed before 30 weeks to determine management until there is evidence that such a high level of unnecessary intervention, as suggested by the treat-all strategy, does less harm than the occurrence of rare false negatives. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

An audit of pregnancies complicated by preeclampsia necessitating in‐utero transfer

An audit of pregnancies complicated by preeclampsia necessitating in‐utero transfer

An audit of in-utero transfers in a district general hospital

Objective: To assess the quantity and nature of transfers from a district general hospital with the aim of identifying suitable outcome measures for the assessment of future service improvements. Background: In-utero transfer is an essential part of daily obstetric practice. A need for an in-utero transfer will arise if the referring unit is unable to cope with the particular clinical condition at the time of transfer for a variety of reasons including: neonatal gestational thresholds, specialist maternal care, antenatal diagnosis requiring specialist postnatal care, bed/cot capacity or staffing issues. It has been reported that most major perinatal centres in the United Kingdom are regularly unable to meet in-house demand. Approximately 25% of women will remain undelivered 96 h after in-utero transfer. To avoid in-utero transfers, which is clearly a source of significant stress and anxiety for parents, the rationale for transfer has to be clear and the final decision made at consultant obstetric level. Method: Retrospective analysis of case notes of women who had in-utero transfers from 01/01/15 to 30/08/15. Results: 39 in-utero transfers identified over the 6 months period. Gestations ranged from 24 + 4 to 36 weeks. 34 of the transfers involved singletons, the other 5 were twin pregnancies. 36 out of the 39 patients (92%) had consent for transfer documented in their notes/IUT proforma. 72% of the transfers were due to cot availability (>28 weeks) in our unit, 10% of these being more that 34 weeks gestation. 14 patients (36%) required tocolytics i.e. Nifedipine or Atosiban prior to or during transfer. Only 33% of the in-utero transfers delivered at the receiving hospital. All 12 patients (31%) with a positive actim partus on transfer were discharged home. Conclusion and recommendations: Our results highlight an apparent lack of capacity in the neonatal service, resulting in considerable numbers in-utero transfers. We need to document maternal consent with every patient being transferred in-utero and to review and develop guidance on the use of Actim Partus in the department.

'It's something you have to put up with'--service users' experiences of in utero transfer: a qualitative study.

The purpose of this study was to gain in-depth insight and enhance understanding of service users' experiences of the in utero transfer (IUT) process, in order to inform policy and improve the current service provision of maternal care. Qualitative descriptive study using semi-structured interviews. Participant's home or hospital in the Midlands, UK. Fifteen women transferred in utero to a tertiary level maternity hospital; five male partners and two grandmothers. Audio-recorded individual or paired semi-structured interviews transcribed verbatum and analysed thematically using nvivo 9. Facilitators and barriers of the IUT experience. Findings suggest that IUT is an emotional experience that financially disadvantages patients and their families. Male partners were perceived to be most negatively affected by the experience. The quality of the IUT experience was influenced by a range of factors, including the lack of proximity to home and the lack of information. Patients had little knowledge or awareness of IUT, and most felt unprepared for displacement. Despite this, there was resigned acceptance that IUT was a necessary rather than adverse experience. The experience of IUT for service users could be enhanced by ensuring that they are better informed about the process and the circumstances that necessitate displacement, that they are better informed about the hospital to which they are being transferred, and that they are transferred as close to home as possible. Efforts to minimise the emotional and socio-economic impact of IUT on women and their families also need to be considered.

PS-289 Does Local Experience In The Management Of Simple Gastroschisis (sg) Matter? (local Practice Versus National Benchmark Data): Abstract PS-289 Table 1

<h3>Background</h3> The most commonly performed procedures for SG are operative primary fascial-closure (OPC) and application of a preformed silo with delayed fascial-closure (PS). There is no consensus on optimal management. <h3>Aim</h3> To compare our outcomes of SG-newborns after OPC with outcomes from a national cohort (British Association of Paediatric Surgeons-Congenital-Anomalies-Surveillance-System, BAPS-CASS) after OPC or PS. <h3>Methods</h3> Retrospective comparison of SG-infants from a tertiary centre (2006–2013) with SG-newborns from BAPS-CASS. We compared baseline characteristics and outcomes: Antenatal diagnosis (AD), in-utero-transfer (IUTR), vaginal delivery (VD), gestational age ≥37 weeks (GA), birthweight ≥ 2500 g (BW), male gender (MALE), associated anomalies (AA); type/success of surgery, re-operation (RE-OP), abdominal compartment (AC), wound infection (WI), mechanical-ventilation (MV), parenteral nutrition &lt;28 days (TPN), intestinal failure associated liver disease (IFALD), length of stay &lt;30 days (LOS) and mortality. Data-presentation: Percentage (%). Data-analysis: Fisher’s-Exact-Test (p &lt; 0.05). <h3>Results</h3> 25 SG-newborns were compared with 336 newborns from BAPS-CASS. Baseline-characteristics were not significantly different (GA 60% vs 57% [p = 0.78], BW 56% vs 43% [p = 0.21]), rest not displayed). Significantly more OPC were intended and successfully completed locally than nationally (96% vs 42% [p &lt; 0.0001]; 100% vs 82% [p = 0.03]). Outcomes were: Compared to national PS TPN and LOS were significantly shorter after OPC locally (80% vs 48%[p = 0.004]; 68% vs 28%[p &lt; 0.0001]); rest of outcomes not significantly different. <h3>Conclusions</h3> Longstanding local experience with OPC positively affects outcomes in SG-infants exceeding some national outcomes irrespective of surgical method.

PA.35 In-Utero Transfers: The Impact of Senior Clinical Discussion on Transfer Decision-Making

IntroductionIn-Utero Transfers (IUTs) are integral to modern perinatal services. Decisions to organise an IUT have not always involved Senior Medical Staff. The Scottish Government Maternity Services Action Group and Neonatal...

Case series: Vitamin D deficiency in exclusively breastfed term and late preterm neonates

Vitamin D plays an integral role in calcium metabolism. Vitamin D levels in neonates are determined by in-utero transfer of vitamin D and through breast milk. This in turn depends on the maternal stores of vitamin D. We present case series of term and late preterm neonates who were admitted to tertiary level neonatal ICU with vitamin D deficiency manifesting as symptomatic hypocalcemia.

PL.42 In Utero Transfer: ‘It’s Something You Have to Put Up with’: A Qualitative Exploration of Its Impact on Families

In utero transfer (IUT) is a necessary facet of contemporary obstetrics, enabling the appropriate level of care for neonates (BAPM 2001). However, quantitative research has demonstrated that IUT can cause...

Need for intensive care for neonates born between 29 and 34 weeks inclusive gestation

To identify the proportion of preterm infants needing neonatal intensive care (NIC) between 29 and 34 weeks gestation. To identify any associated risk factors. This population-based study identified all babies, born without congenital abnormalities, between 29 and 34 weeks gestation inclusive. A 21-month period ending September 2009 was used. The need for NIC was defined using specific cardiorespiratory and nutritional criteria. The use of continuous positive airway pressure alone was not included as a need for NIC. Data were extracted from a neonatal clinical database and individual medical records. Complete data were available from 707 out of 709 eligible infants born in the study period. The percentage of infants requiring cardiorespiratory support varied from 39 to 2.7% at 29 and 34 weeks, respectively. If nutritional criteria were included, this increased to 77% at 29 weeks and 7.2% at 34 weeks. Multivariate analysis determined that gestational age and delivery by Caesarean section increased the need for intensive care (P-value <0.01). Antenatal steroids, gender, underlying maternal medical conditions, being small for gestational age or twin pregnancy had no statistically significant impact. This study supports the National Health and Medical Research Council Guidelines of in-utero transfer at <33 weeks gestation. Gestational age and delivery by Caesarean section remain major indicators for the need for NIC. In special care nurseries that have the capability and expertise to use nasal continuous positive airway pressure, the main indication for NIC is for nutritional support.

Surfactant era and obstetric decision making

Introduction: The management of women with pregnancy complications at the peri-viability period involves a complex set of medical, ethical, emotional, and social challenges for the obstetrician. The survival rate of preterm babies has been improving along with advancement in neonatal intensive care unit (NICU) technology. Our recent experience has shown survival of even very preterm infants with the use of surfactant therapy. Objective: This observational study was conducted in order to evaluate the survival benefit of surfactant therapy on preterm neonates, to enable straight forward decisions to be taken by the obstetricians regarding antenatal steroid prophylaxis, in-utero transfer and mode of delivery in case of inevitable preterm births. Material and Methods: This study was conducted in the NICU of a tertiary hospital over a period of 3 years (2009-2011). We recruited only those preterm neonates who received surfactant therapy and the records were obtained and analyzed. Survival benefits of surfactant therapy, role of antenatal steroids, in utero transfer and mode of delivery were studied. Results: Almost all (98.6%) neonates who did not receive antenatal steroids at all, landed up in respiratory distress syndrome (RDS) requiring surfactant therapy. Among the outborns 59.2% had an extended NICU stay as compared to 49.4% in the inborn group. The overall incidence of RDS was found to be more in caesarean delivery group (96.3%). However if the period of gestation at the time of delivery was less than 28 weeks, caesarean delivery had lesser incidence (12.5%) of RDS compared to vaginal delivery (27.1%). Similar finding was noted when comparing mortality. In less than 28 weeks gestation, when caesarean was done 2.5% newborn babies died, whereas in the vaginal delivery group 12.5% babies succumbed to death. Conclusion: 1) Even in centers with facilities of surfactant therapy, steroids prophylaxis should be considered before delivery 2) Obstetricians should practice in utero transfer, to centers with NICU, having availability and technical expertise of surfactant prophylaxis 3) With the availability and wide spread usage of surfactant for premature neonates caesarean delivery should not be deferred for fetal benefit. DOI: http://dx.doi.org/10.4038/sljog.v34i3.4882 Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34 : 99-105

O087 AUDIT OF IN-UTERO TRANSFERS FOLLOWING INTRODUCTION OF RAPID FETAL FIBRONECTIN TEST FOR ASSESSMENT OF PRETERM LABOUR IN A DISTRICT GENERAL HOSPITAL IN UNITED KINGDOM

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S291-S291 Free communication (oral) presentations O087 AUDIT OF IN-UTERO TRANSFERS FOLLOWING INTRODUCTION OF RAPID FETAL FIBRONECTIN TEST FOR ASSESSMENT OF PRETERM LABOUR IN A DISTRICT GENERAL HOSPITAL IN UNITED KINGDOM S. Basak, S. BasakSearch for more papers by this authorV. Babbur, V. BabburSearch for more papers by this author S. Basak, S. BasakSearch for more papers by this authorV. Babbur, V. BabburSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60517-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S291-S291 RelatedInformation

Does facility-based newborn care improve neonatal outcomes? A review of evidence

Facility based newborn care is gaining importance as an intervention aiming at reduction of neonatal mortality. To assess different factors that affect effectiveness of facility based newborn care on neonatal outcomes. Electronic search using key search engines along with search of grey literature manually. Observational and interventional studies published between 1966-Aug 2010 in English having a change in neonatal mortality as an outcome measure were considered. A total of 40 articles were fully reviewed for generating synthesized evidence. All were observational studies. The exposure variables that affected neonatal outcomes were grouped into three categories- regionalization of perinatal care (17 articles), strengthening of lower level neonatal facilities (12), and other miscellaneous factors (11). Regionalization played a key role in advancing newborn care practices. It increased in-utero transfer of high risk newborns and improved survival outcomes especially for very low birth weight neonates at level III facilities. It led to reduction in neonatal mortality owing primarily to enhanced survival of low birth weight infants. Strengthening of lower level units contributed significantly in reducing neonatal mortality. High patient volume (>2,000 deliveries/year), inborn status, availability of referral system and inter-facility transfers, and adequate nursing care staff in neonatal units also demonstrated protective effect in averting neonatal deaths. Countries investing in facility based newborn care should give impetus to establishing regionalized systems of perinatal care. Strengthening of lower level units with high case loads, can yield optimal reduction in NMR.

Impact of antenatal tests on acute in-utero transfers

BackgroundFewer than 50% of mothers referred for acute in-utero transfer (IUT) from the East of England (EoE) region deliver within 7 days. Appropriate antenatal tests for symptomatic women are recommended.1...

Efficacy of fibronectin and its impact on the use of atosiban – cost implication

AimOur aim of this audit was to assess the effectiveness of fetal fibronectin test and the cost impact of its introduction.FindingsOver the 3month period 39 tests were done. Data was...

Phosphorylated insulin-like growth factor binding protein-1 (ACTIM PARTUS) testing in management of threatened preterm labour

IntroductionPreterm labour is one of the commonly encountered problems in pregnancy complicating nearly 20% of women. It is not only a cause for increased perinatal morbidity and mortality, but also...

To assess the potential use of tocolytic agents in a center with a low rate of preterm labour (< 34 weeks)

BackgroundTocolytics are not used in this center.Purpose of studyTo try and determine who might potentially benefit from tocolytics.Study design and MethodsThis was a consecutive observational cohort study (Jan 2008 to...

Profile Of In-Utero Transfers in Yorkshire &amp; Humber - Embrace Transport Service

Background and Aims: Embrace, combined paediatric and neonatal transport service for Yorkshire and Humber, facilitates in-utero transfers for a region with 75,000births/year. Our aim was to evaluate in utero transfer requests - indications for transfer, time spent locating cot/ bed, fibronectin use and outcomes. Methods: Prospective audit of in-utero requests during 1/10/2010 - 7/01/2011. Data obtained via audit proforma and phone calls to maternity units. Results: 86 transfers were facilitated out of 120 in-utero requests. The main reasons for requests were lack of neonatal cots 54% (65/120), maternal conditions requiring specialist care 2.5% (3/120), preterm gestation 24% (29/120) and impending preterm labour 7.5% (9/120). 13/120 of total requests - out of region cot located. 34 did not result in transfer despite cot/bed being located. The reasons were: Tertiary perinatal centres accepted 41% transfers. Mean time facilitating transfers - 82 minutes. Mean number of phone calls - 6.3. On average to organise 1 successful IUT, 2.1 maternity units and 3.4 neonatal units contacted. 50% of mothers delivered within 24 hrs of transfer. 13.3 % referrals used fibronectin. Conclusion: IUT are a significant part of Embrace's workload. Increased use of fibronectin in impending deliveries would enhance appropriateness of transfers.

In-utero transfer is too difficult: Results from a prospective study

BackgoundPerinatal transfer is an unavoidable part of neonatal care. In-utero as opposed to postnatal transfer is recommended whenever possible. AimsTo quantify prevalence of in-utero transfers, determine the duration of time spent arranging in-utero transfers and whether failures in the organisation of potential in-utero transfers were occurring. Study designProspective study of in-utero transfers referred and completed, and questionnaire study of failed potential in-utero transfers. SubjectsWomen referred to the Emergency Bed Service (EBS), women undergoing in-utero transfer by London Ambulance Service (LAS), and preterm infants undergoing postnatal transfer where in-utero transfer had been potentially achievable, in the London area, over a six month period in 2009. Outcome measuresNumber of in-utero transfers being undertaken, duration of time spent arranging in-utero transfer, and number of failed in-utero transfers. ResultsOver the study period LAS undertook 438 in-utero transfers and there were 338 referrals for in-utero transfer to EBS, of which 180 (53%) were successful. Of 69 emergency postnatal transfers of preterm infants (<29weeks gestational age), 11 were classified as failed in-utero transfers. Median (IQR) duration of EBS involvement in in-utero referrals was 340 (200–696)min. A median (IQR) of 240 (150–308)min was spent contacting a median (IQR) of 7 (6–8)units when attempting to arrange in-utero transfer in the failed in-utero transfer group. ConclusionsArranging in-utero transfer consumes considerable clinical time; an important number of in-utero transfer attempts fail for non-clinical reasons; establishment of a centralised in-utero transfer planning service will save clinical time and may improve outcomes.

Les naissances des grands prématurés en dehors des maternités de type III sont-elles évitables ? Expérience du réseau Grand Lyon

Objective The main objective of this study was to calculate the percentage of preterm births before 28 weeks gestational age (weeks GA) outside level-3 maternity wards and determine how many could have been prevented. Methods This was an observational, multicenter, retrospective cohort study, which included all the deliveries that occurred between 24 and 27 weeks GA + 6 days in the Greater Lyon perinatal network (France) occurring between first of March 2008 and first of March 2009. In utero transfers (IUTs) and newborn transfers (NBTs) which were carried out outside the network, medical abortions, and foetal deaths in utero were excluded. The duration between patient's arrival in the level 1 and 2 maternity and birth was compared at the 97 th percentile of the mother's transfer time in level-3 maternity. Births that occurred outside of level-3 maternity wards were considered avoidable each time the first duration was more than the second. Results During the study period, 113 infants were born alive between 24 and 27 weeks GA + 6 days in the network. They were all included in the study. Ninety were born in a level-3 maternity ward and 23 were born in level-1 and 2 maternity wards (20%). There were 35 requests for IUT and 28 were carried out (80%). In 65% of non-level 3 births, no IUT was requested. In 17% of cases, an IUT request could have prevented births in level 1/2 maternity wards. If twin pregnancies had been transferred to a level-3 maternity ward, 26% of non-level 3 births would have been avoided. If all high-risk pregnancies had been transferred to a level-3 maternity ward, 40% of non-level 3 births would have been avoided. Discussion and conclusion Any time a pregnant woman is hospitalized in a type 1/2 maternity ward before 28 weeks GA, doctors should consider an in utero transfer to a level-3 maternity ward. It may be possible to lower the birth-rate of non-level 3 births by a targeted increase in in utero transfers and by transferring high-risk pregnancies to a level-3 maternity ward.

In utero transfers across yorkshire and the humber by embrace transport service

Embrace, combined paediatric and neonatal transport service for Yorkshire and Humber, is also a cot locator to facilitate in-utero transfers for a region with 75 000 births/year.AimsTo evaluate in utero...