Authors
Cetin I, Schlembach D, Simeoni U, Nagy Bonnard L, Bernloehr A, Gente M, Grosek S, Jourdain G, Kainer F, Radzeviciene L, Ratnavel N, Rossi R, Roth-Kleiner M
Authors
Cetin I, Schlembach D, Simeoni U, Nagy Bonnard L, Bernloehr A, Gente M, Grosek S, Jourdain G, Kainer F, Radzeviciene L, Ratnavel N, Rossi R, Roth-Kleiner M
Healthcare professionals, perinatal units, hospitals, and health services
Transfer of pregnant women for specialist care (for mother and/or newborn infant) is an essential component of perinatal care and is carried out in a timely, safe and efficient manner.
As newborn infants born to women transferred antenatally have better outcome than those transferred postnatally, the primary goal of perinatal centralisation is that women and newborn infants receive obstetric and neonatal care in appropriate facilities. Maternal transfer refers to the transfer of a pregnant woman during the ante-, intra- and occasionally also postpartum period for special care of the woman, the newborn infant, or both. (1–15)
Antepartum transfer avoids separation of mother and the newborn infant in the immediate postpartum period, allows mothers to communicate directly with neonatal intensive care unit (NICU) healthcare providers, and supports the goal of family-centred care. (16) Establishing uniform indications and contraindications for maternal transfer and formal transfer agreements (emphasising needs and requirements and capacity of local resources and facilities) will help to ensure safe transfer. (12,15)
The main factor to consider when deciding the need for maternal transfer is that expected benefits outweigh potential risks of maternal transfer. (12,15) The condition to be ultimately avoided is a birth occurring during maternal transfer. In case this is foreseen, and the centre does not have the appropriate level of care for that birth, neonatal transfer has to be organised immediately, according to the clinical, structural and geographical situation already before birth. (1,2,12–15,17,18)
Component | Grading of evidence | Indicator of meeting the standard | |
For parents and family | |||
1. | Expectant parents are referred prenatally to the appropriate centre. (11,25–29) | A (High quality) B (High quality) |
Audit report, clinical records |
2. | Expectant parents are counselled about the reasons for maternal transfer by healthcare professionals. | B (High quality) | Patient information sheet |
For healthcare professionals | |||
3. | A unit guideline on maternal transfer identifying different degrees of urgency is adhered to by all healthcare professionals. | B (High quality) | Guideline |
4. | Training on the indications and contraindications for maternal transfer is attended by all responsible healthcare professionals. (12,15,30) | A (High quality) B (High quality) |
Guideline, training documentation |
5. | Training on neonatal life support is attended by all responsible healthcare professionals. (see TEG Education & training) | B (High quality) | Training documentation |
For perinatal units | |||
6. | A unit guideline on maternal transfer identifying different degrees of urgency is available and regularly updated. | B (High quality) | Guideline |
7. | Step down care and transfer back to referring hospital is provided as soon as clinically indicated. (25) | A (Low quality) B (High quality) |
Audit report, clinical records |
8. | Adherence to the requirements and boundaries of the assigned level of care is ensured. | C (Moderate quality) | Audit report, guideline |
9. | Units are part of a regional perinatal network. | B (Moderate quality) C (Moderate quality) |
Audit report |
For hospital | |||
10. | Training on the indications and contraindications for maternal transfer as well as neonatal life support is ensured. | B (High quality) | Training documentation |
11. | Appropriate resources necessary to facilitate maternal transfer are available, including an appropriately trained team. (12,14,15) | A (High quality) C (Moderate quality) |
Audit report, training documentation |
For health service | |||
12. | A national guideline on maternal transfer identifying different degrees of urgency is available and regularly updated. | B (High quality) | Guideline |
13. | A real-time system to identify availability of beds (maternal/neonatal) is established. | B (Moderate quality) | Audit report |
14. | A regional perinatal transfer network according to the local necessities (distance, geographic peculiarities, communication) in order to ensure safety requirements for maternal/neonatal transfer is designed and quality is regularly controlled. (23,31) | C (Low quality) | Audit report |
Further development | Grading of evidence | |
For parents and family | ||
N/A | ||
For healthcare professionals | ||
N/A | ||
For perinatal unit | ||
N/A | ||
For hospital | ||
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B (Moderate quality) | |
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B (Moderate quality) | |
For health service | ||
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B (Moderate quality) | |
Initial steps | |
For parents and family | |
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For perinatal unit | |
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For hospital | |
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For health service | |
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When preterm or medical complications are anticipated, early consultation with and transfer to the appropriate centre as necessary is mandatory. The most common obstetric indications for maternal transfer* (12,14,15)
*Usually for gestational ages below 32 or 34 weeks, depending on the health service structure Under some circumstances, maternal transferis not possible, such as: (12,14,15)
Consent for transfer
Appropriate time should be dedicated to explaining to the mother and the family the reasons for transfer and provide adequate directions for the family to the new centre.
Equipment for maternal transfer (14,15)
Appropriate transferprotocols should be available, in particular for emergency events occurring during transfer such as eclamptic fits, placental abruption, cord prolapse, delivery during transfer, neonatal resuscitation, post-partum haemorrhage, sepsis, maternal cardiac arrest.
Drugs with the best safety profile should be utilised during transfer, i.e. tocolytics with less maternal side effects. MEOWS (maternal early warning signs) charts should be filled in during transfer. (33,34)
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Cetin I, Schlembach D et al. European Standards of Care for Newborn Health: Maternal transfer for specialist care. 2018.