title: In-utero transfer is too difficult: results from a prospective study.
abstract: BACKGROUND
  Perinatal transfer is an unavoidable part of neonatal care. In-utero as opposed to postnatal transfer is recommended whenever possible.
  
  
  OBJECTIVE
  To quantify prevalence of in-utero transfers, determine the duration of time spent arranging in-utero transfers and whether failures in the organisation of potential in-utero transfers were occurring.
  
  
  METHODS
  Prospective study of in-utero transfers referred and completed, and questionnaire study of failed potential in-utero transfers.
  
  
  METHODS
  Women referred to the Emergency Bed Service (EBS), women undergoing in-utero transfer by London Ambulance Service (LAS), and preterm infants undergoing postnatal transfer where in-utero transfer had been potentially achievable, in the London area, over a six month period in 2009.
  
  
  METHODS
  Number of in-utero transfers being undertaken, duration of time spent arranging in-utero transfer, and number of failed in-utero transfers.
  
  
  RESULTS
  Over the study period LAS undertook 438 in-utero transfers and there were 338 referrals for in-utero transfer to EBS, of which 180 (53%) were successful. Of 69 emergency postnatal transfers of preterm infants (<29 weeks gestational age), 11 were classified as failed in-utero transfers. Median (IQR) duration of EBS involvement in in-utero referrals was 340 (200-696)min. A median (IQR) of 240 (150-308)min was spent contacting a median (IQR) of 7 (6-8)units when attempting to arrange in-utero transfer in the failed in-utero transfer group.
  
  
  CONCLUSIONS
  Arranging in-utero transfer consumes considerable clinical time; an important number of in-utero transfer attempts fail for non-clinical reasons; establishment of a centralised in-utero transfer planning service will save clinical time and may improve outcomes.
authors.affiliation: Neonatal Transport Team, Royal London Hospital, London, United Kingdom. christopher.gale@imperial.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Gale
authors.forename: A
authors.initials: A
authors.lastname: Hay
authors.forename: C
authors.initials: C
authors.lastname: Philipp
authors.forename: R
authors.initials: R
authors.lastname: Khan
authors.forename: S
authors.initials: S
authors.lastname: Santhakumaran
authors.forename: N
authors.initials: N
authors.lastname: Ratnavel
mesh_terms: D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008131:London; D011247:Pregnancy; D011446:Prospective Studies; D014187:Transportation of Patients