All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change

Abstract

The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (“in utero”). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of in utero transfers compared to ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.

Perceived stress and its predictors in women with threatened preterm labour: A cross‐sectional study

“…Also, no original study was found that compared the two groups. However, a study based on the case reports in the United Kingdom report that referral and dispatching of pregnant women to more well-equipped centres imposes additional psychological stress on them (Musson & Harrison, 2016;Watson et al, 2020). This report does not appear to be consistent with the results of our study.…”

Validation of a Nomogram for Predicting Preterm Birth in Women With Threatened Preterm Labor: A Prospective Cohort Study in Iranian Tertiary Referral Hospitals

“…Threatened preterm labor (TPL) is one of the pregnancy complications that frequently leads to hospitalization of pregnant women (Bendix et al, 2016) or their referral to tertiary healthcare centers (Watson et al, 2020). In recent years, the survival rate of premature neonates has increased by using antenatal interventions such as administration corticosteroids and in utero transfer (Synnes et al, 2017; Watson et al, 2020). However, transferring women with TPL to the tertiary health care unit is costly and time-consuming and imposes considerable stress burden to the women and their families (Watson et al, 2020).…”

“…In recent years, the survival rate of premature neonates has increased by using antenatal interventions such as administration corticosteroids and in utero transfer (Synnes et al, 2017; Watson et al, 2020). However, transferring women with TPL to the tertiary health care unit is costly and time-consuming and imposes considerable stress burden to the women and their families (Watson et al, 2020). Considering that, not every hospitalized and transferred woman goes into preterm birth (Carter et al, 2018; Vivanti et al, 2019), it is essential to conduct a precise clinical assessment in order to prevent unnecessary referrals and interventions (Boland et al, 2017; Carter et al, 2018; Dabi et al, 2017; Vivanti et al, 2019).…”

Oral nifedipine and parenteral isoxsuprine in arresting preterm labor

“…[ 6 ] They tend to decrease the intracellular calcium ion availability through various mechanisms, causing inhibition of interaction between actin and myosin. [ 8 9 ]…”