The transport of pregnant women and newborns at high risk for problems should be considered when it is felt that the resources in the local community are inadequate to provide immediate and ongoing safe care of the woman and her unborn baby or infant and manage possible complications. In general, outcome for babies who may need high intensity care in the newborn period improves if the baby's mother can be safely transported antenatally to a centre that can provide the required obstetric care for her and after-birth support for her infant.
|
Although the majority of transfers are to a Level III perinatal centre, transfer to a Level II centre may be safer and more appropriate, allowing the family to remain closer to home. The level III perinatal centres in Victoria are The Mercy Hospital for Women (Heidelberg), Monash Medical Centre (Clayton) and The Royal Women's Hospital (Carlton); each centre has around the clock specialist high-risk obstetric and midwifery teams and a neonatal intensive care unit. The Royal Children's Hospital (Parkville) also provides neonatal intensive care.
|
The indications for maternal transport may relate to the woman or to the unborn baby:
|
- when the mother or baby requires the advanced skills and resources of a Level II or III center;
|
- when it is expected that the infant will need care in a Level III neonatal intensive care unit or a Level II or III special care nursery.
|
|
The method and timing of transfer will depend on the clinical circumstances and the distances and, at times, the geographic and climatic conditions.
|
The most frequent reasons to consider maternal transport are:
|
- threatened preterm birth due to preterm labour or preterm rupture of membranes
|
- severe pre-eclampsia or other hypertensive complications of pregnancy
|
|
|
|
At times, other issues may have a significant bearing on the problem:
|
|
- intrauterine growth restriction
|
- suspected fetal abnormalities
|
|
Transport of any patient is potentially dangerous, and the risks of transport / transfer must always be taken into account when such decisions are being taken. A planned and measured approach prior to a transfer should make transfer, when it is appropriate, uneventful.
|
An aircraft is not an appropriate place for a birth to occur. In the situation of a woman with a serious perinatal problem combined with, or due to, preterm labour transport may only be appropriate if labour is suppressed; otherwise it may be more appropriate for the baby to be born locally and mother and baby subsequently transported as required.
|
