In-Utero Transfer RWHT & UHNS 2010-15 Tracey Vanner (Consultant Obstetrician) Mary Rooney (Senior Midwife) Royal Wolverhampton Hospitals NHS Trust 23/02/2019

SSBC Network Prospective Audit of IUT IUT form developed by SSBC Maternity Network Carbonated copy retained in receiving unit Process for follow up established Anonymous database held by SSBC Network RWHT commenced audit April 2009 UHNS joined audit August 2009 Audit period 2010-2015 for RWHT Audit period 2011 to June 2015 for UHNS Some data items incomplete for UHNS 23/02/2019

RWHT Transfers & Births 23/02/2019

UHNS Transfers & Births 23/02/2019

Transferring Units RWHT (% of transfers by Network) 23/02/2019

Transferring Units UHNS (% of transfers by Network) 23/02/2019

RWHT IUT Gestation (% by gestation range) 23/02/2019

RWHT Clinical Indication for IUT (% by indication) 23/02/2019

RWHT Outcome by Indication for IUT 2014 & 2015 23/02/2019

Threatened Pre-term Labour Threatened PTL remains the leading indication for IUT For the period 2011-13 27% of women with threatened PTL gave birth, for 2014-15 this has fallen to 9% (RWHT data) FFN or equivalent testing has improved. Only 1 woman was transferred with a negative result and 1 unit did not have a test available in 2014. New NICE guidance on PTL encourages a low threshold for IUT. The numbers transferred are therefore likely to increase and the proportion that give birth to fall further. 23/02/2019

Steroids & Tocolytics Steroids were commenced in all cases before transfer when indicated and the course completed before delivery where possible Tocolysis was commenced & continued for the transfer where indicated. Atosiban remains the most frequently used tocolytic

Summary The proportion of transfers remaining within the SSBC network has improved. The adjacent SWM network is the next most frequent origin of transfers. The proportion of transfers at the earlier gestations has improved suggesting that capacity and/or the understanding of patient pathways has improved. Threatened Pre-term labour remains the leading indication for IUT and the majority are still undelivered at discharge.