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Review
. 2020 Aug 13:9:F1000 Faculty Rev-979.
doi: 10.12688/f1000research.25923.1. eCollection 2020.

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

Helena Watson  1   2 , James McLaren  3 , Naomi Carlisle  2 , Nandiran Ratnavel  4 , Tim Watts  1 , Ahmed Zaima  5 , Rachel M Tribe  2 , Andrew H Shennan  1   2
Affiliations
Review

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

Helena Watson et al. F1000Res. .

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.

Keywords: in-utero transfer; preterm birth.

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Conflict of interest statement

No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Indications for in utero transfer.
This figure was adapted from a previous publication by the authors with permission from London Neonatal Operational Delivery Network.
Figure 2.
Figure 2.. Contra-indications for in utero transfer.
This figure was adapted from a previous publication by the authors with permission from London Neonatal Operational Delivery Network.
Figure 3.
Figure 3.. Main messages and recommendations reported in the Pan-London In Utero Transfer Guidance: Changing the Conversation.
This figure was adapted from a previous publication by the authors with permission from London Neonatal Operational Delivery Network.
Figure 4.
Figure 4.. CotFinder app screenshots.
See this image and copyright information in PMC

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