In-utero (maternal) transfer to another hospital

What it is

The transport of pregnant women at high risk for problems, to a facility that can provide the required obstetric and neonatal care, is recognized as an essential component of modern prenatal care. An in-utero transfer of a woman from one hospital to another for delivery and further management is a joint discussion made by the transferring obstetric consultant and the neonatal consultant, in liaison with the woman and her husband, the neonatal nurse, and the delivery suite coordinator.

Maternal agreement is verbal consent, obtained before transfer and documented; it usually requires joint counseling by obstetric and neonatal doctors.

When it is done

Five indications for in-utero transfer, and note that all five are about SQUH, the hospital the woman is transferred from, and not about the woman: a requirement for services not available at SQUH; the neonatal unit is closed; lack of availability of a neonatal bed; a neonatal team request due to shortage of staff and workload; and the labour and delivery ward is closed or no beds are available.

Seven common indications for maternal transport, and these are the obstetric ones: preterm labour; PPROM; severe gestational hypertension or other hypertensive complications; APH but the woman's condition is stable; intrauterine growth restriction requiring delivery; fetal abnormalities requiring intervention; and maternal trauma.

Feasibility turns on two things: how much time is available before either anticipated delivery or an intervention is required, and what is the travel time to the nearest available appropriately staffed and resourced delivery ward or NICU.