title: Outcomes of high-risk obstetric transfers in New South Wales and the Australian Capital Territory: The High-Risk Obstetric Transfer Study.
abstract: BACKGROUND
  In New South Wales and the Australian Capital Territory, in utero transfers to manage maternal or neonatal risks are highly challenging owing to geography and centralisation of tertiary perinatal care.
  
  
  OBJECTIVE
  The study aims to document the outcomes of high-risk obstetric transfers.
  
  
  METHODS
  A prospective observational study was conducted from 2010 to 2011 documenting urgent requests for obstetric transfers to tertiary centres across NSW/ACT for pregnancies 20 weeks' gestation or greater. Outcomes of transfers were allocated apriori to 'delivered at the receiving hospital', 'failed/delayed transfer' or 'discharged/transferred undelivered'. Our hypothesis is that each outcome has a specific group of associated clinical factors.
  
  
  RESULTS
  Of the 249 transfer requests included in the study, 40% delivered at the receiving hospital, 7% were failed/delayed transfers, and 45% were discharged/transferred undelivered. Cases delivering at the receiving hospital were significantly associated with older mothers, twin pregnancies, pregnancy induced hypertension (PIH) or premature rupture of membranes (PROM) with/without threatened preterm labour (TPL) as the indications for transfer and having three indications for transfer. Cases that were discharged/transferred undelivered were significantly associated with singleton pregnancies, TPL and/or antepartum haemorrhage (APH) as the indication for transfer and having one indication for transfer. There were no significantly associated factors for failed/delayed transfers.
  
  
  CONCLUSIONS
  The study confirms the hypothesis that particular transfer outcomes are associated with different factors. The findings also show that less than half of urgent obstetric transfers result in delivery at the receiving hospital, suggesting that there exists significant opportunities for further research into predicting preterm delivery, thereby improving the care of women with high-risk pregnancies.
authors.affiliation: Department of Obstetrics and Gynaecology, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Goh
authors.affiliation: Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.|Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Browning Carmo
authors.affiliation: Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St. Leonard, New South Wales, Australia.|University of Sydney Medical School, Sydney, New South Wales, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Morris
authors.affiliation: Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Berry
authors.affiliation: Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Wall
authors.affiliation: Neonatology Unit, Canberra Hospital, Garran, Australian Capital Territory, Australia.|The Clinical School, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Latif
mesh_terms: D000328:Adult; D020958:Australian Capital Territory; D015331:Cohort Studies; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D004630:Emergencies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D009517:New South Wales; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011446:Prospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: perinatal care; pregnancy; preterm birth; tertiary care centres/statistics and numerical data