Birth & transfer

Overview

Pregnancy and childbirth represent a critical time period requiring proper counselling about potential pregnancy complications. Women – especially those at risk – can be supported by a broad range of interventions that aim at reducing the risk of preterm birth and improving the health of mother and infant.

One aspect is that the regional organisation of perinatal care needs to be based on designated centres of care, categorised as specialist or non-specialist centres, specifying activity that is appropriate in each.(1–5) In order to manage women at risk, to prevent preterm birth, and to ensure appropriate care for preterm infants, differentiation between low-risk and high-risk pregnancies is important. One essential component of obstetric care is the education of pregnant women about signs and symptoms of preterm birth (6–9), as it fosters the early identification of women at risk for pregnancy complications and preterm birth.

In critical situations during the ante-, intra- and post-partum period, maternal and/or neonatal transfer may be required, as provision of specialist care may reduce the incidence of preterm birth and the associated fetal/neonatal and maternal complications. (5,10,11) As newborn infants born to women transferred antenatally have better outcomes than those transferred postnatally, the primary goal of perinatal centralisation is that women and newborn infants receive obstetric and neonatal care in appropriate facilities. (5,10,11) It is important to recognise that neonatal transports, when necessary, are a critical phase with specific needs for a specialised team and equipment to ensure maximal safety and efficiency. (12) Both maternal and neonatal transfer should be carried out in a timely, safe, and efficient manner, following the aim to avoid separation of mother and baby.

The Topic Expert Group on Birth and transfer develops standards on organisational aspects of perinatal care, including antenatal transport of the mother with her baby in the womb and adequate intra- and inter-hospital transport of the newborn baby. Furthermore, the standards focus on information provision and counselling about potential risk factors for preterm birth.

Neto MT. Perinatal care in Portugal: effects of 15 years of a regionalized system. Acta Paediatr Oslo Nor 1992. 2006 Nov;95(11):1349–52.
American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics. 2012 Sep;130(3):587–97.
American College of Obstetricians and Gynecologists and Society for Maternal–Fetal Medicine, Menard MK, Kilpatrick S, Saade G, Hollier LM, Joseph GF, et al. Levels of maternal care. Am J Obstet Gynecol. 2015 Mar;212(3):259–71.
Poets CF. Perinatal regionalisation in the UK: an international perspective. Arch Dis Child Fetal Neonatal Ed. 2014 May;99(3):F176.
American Academy of Pediatrics, American College of Obstetricians and Gynecologists, editors. Guidelines for perinatal care. 7th ed. Elk Grove Village, IL : Washington, DC: American Academy of Pediatrics ; American College of Obstetricians and Gynecologists; 2012. 580 p.
Delnord M, Blondel B, Zeitlin J. What contributes to disparities in the preterm birth rate in European countries? Curr Opin Obstet Gynecol. 2015 Apr;27(2):133–42.
Koullali B, Oudijk MA, Nijman T a. J, Mol BWJ, Pajkrt E. Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med. 2016 Apr;21(2):80–8.
Mehta-Lee SS, Palma A, Bernstein PS, Lounsbury D, Schlecht NF. A Preconception Nomogram to Predict Preterm Delivery. Matern Child Health J. 2017 Jan;21(1):118–27.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The Lancet. 371(9606):75–84.
Wilson AK, Martel M-J, Arsenault M-Y, Cargill YM, Delaney M, Daniels S, et al. Maternal transport policy. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2005 Oct;27(10):956–63.
Scott J. Obstetric Transport. Obstet Gynecol Clin North Am. 2016 Dec;43(4):821–40.
Orr RA, Felmet KA, Han Y, McCloskey KA, Dragotta MA, Bills DM, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009 Jul;124(1):40–8.