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

Gale, Chris; Hay, Anna; Philipp, Claire S.; Khan, Rehan Ullah; Santhakumaran, Shalini; Ratnavel, Nandiran

doi:10.1016/j.earlhumdev.2011.07.016

Cited by 25 publications

(21 citation statements)

References 8 publications

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“…Transfers of women prior to delivery are generally preferable because they are believed to be safer and less expensive than postnatal transfers of vulnerable infants 32. However, a study in 2009 showed that almost one-half of all in utero transfer requests to the London Ambulance Service were unsuccessful for non-clinical reasons 33. Furthermore, studies from other countries, including Portugal, Finland and the USA, have shown that in more regionalised systems as many as 90–95% of very preterm or VLBW infants are born in hospitals with tertiary designation neonatal units 10 34 35.…”

Section: Discussionmentioning

confidence: 99%

The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study

et al. 2014

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ObjectiveTo examine the effects of designation and volume of neonatal care at the hospital of birth on mortality and morbidity outcomes in very preterm infants in a managed clinical network setting.DesignA retrospective, population-based analysis of operational clinical data using adjusted logistic regression and instrumental variables (IV) analyses.Setting165 National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing and Clinical Outcomes Project.Participants20 554 infants born at <33 weeks completed gestation (17 995 born at 27–32 weeks; 2559 born at <27 weeks), admitted to neonatal care and either discharged or died, over the period 1 January 2009–31 December 2011.InterventionTertiary designation or high-volume neonatal care at the hospital of birth.OutcomesNeonatal mortality, any in-hospital mortality, surgery for necrotising enterocolitis, surgery for retinopathy of prematurity, bronchopulmonary dysplasia and postmenstrual age at discharge.ResultsInfants born at <33 weeks gestation and admitted to a high-volume neonatal unit at the hospital of birth were at reduced odds of neonatal mortality (IV regression odds ratio (OR) 0.70, 95% CI 0.53 to 0.92) and any in-hospital mortality (IV regression OR 0.68, 95% CI 0.54 to 0.85). The effect of volume on any in-hospital mortality was most acute among infants born at <27 weeks gestation (IV regression OR 0.51, 95% CI 0.33 to 0.79). A negative association between tertiary-level unit designation and mortality was also observed with adjusted logistic regression for infants born at <27 weeks gestation.ConclusionsHigh-volume neonatal care provided at the hospital of birth may protect against in-hospital mortality in very preterm infants. Future developments of neonatal services should promote delivery of very preterm infants at hospitals with high-volume neonatal units.

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Section: Discussionmentioning

confidence: 99%

The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study

et al. 2014

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“…NICE modeled for this potential effect by allowing £300 for ambulance costs. However, the clinical and financial impacts of unnecessary in‐utero transfers are likely to far exceed this estimate owing to the stress and expense experienced by the mother and her family and the immediate clinical burden of transfer arrangements. Paradoxically, unwarranted antenatal transfers may increase the number of more dangerous postnatal transfers by impairing efficient management of neonatal cots (using cots reserved for babies that are not actually delivered preterm).…”

Section: Discussionmentioning

confidence: 99%

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

Watson

Carter

Seed

et al. 2017

Ultrasound in Obstet & Gyne

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“…13 Current research in IUT, for example, is dominated by quantitative studies focused on the number of transfers, pregnancy outcomes, and service audits or evaluations. [14][15][16][17][18][19][20][21] The efficacy of IUT versus ex utero transfer has also been debated, 22,23 and the obstetrician's perspective has been explored; 24,25 however, the experience of IUT and its impact on women and their families has largely been ignored. 15,26 The few studies that have considered this population are quantitative in design and offer few experiential insights.…”

Section: Introductionmentioning

confidence: 99%

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

Porcellato

Masson

O’Mahony

et al. 2015

BJOG

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Objective 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.Design Qualitative descriptive study using semi-structured interviews.Setting Participant's home or hospital in the Midlands, UK.Population Fifteen women transferred in utero to a tertiary level maternity hospital; five male partners and two grandmothers.Methods Audio-recorded individual or paired semi-structured interviews transcribed verbatum and analysed thematically using NVIVO 9.Main outcome measures Facilitators and barriers of the IUT experience.Results 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.Conclusions 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.

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

Cited by 25 publications

References 8 publications

The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study

The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study

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

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

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