1. In-Utero Transfer 2007 - 2011 Tracey Vanner Consultant Obstetrician
Mary Rooney Senior Midwife
Royal Wolverhampton Hospitals NHS Trust
05/12/2018

2. Summary of RWHT Audit 2007 Local (within network/adjacent network)
82% of IUTs were local
Determined by level of care required
47% determined by level of care not capacity
Necessary transfers maximised
46% of IUTs resulted in a birth
Unnecessary transfers minimised
74% of women in threatened PTL were discharged
05/12/2018

3. SSBC Newborn Network
05/12/2018

4. 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 commenced audit August 2009
05/12/2018

5. In-Utero Transfer 2007 - 2011 RWHT trends in; numbers of IUTs
outcome of IUT
referring units
indication for IUT and outcome
IUT data for UHNS 2011

6. Trends in number of Transfers and Births RWHT

7. Births

8. Transferring Units (n)

9. Transferring Units (n)

10. Indication for IUT (%)
05/12/2018 10

11. Threatened Pre-term Labour
In % of IUTs were for PTL
74% were discharged home still pregnant
FFN data not available
In % of IUTs were for PTL
78% were discharged home still pregnant
FFN in 50% prior to transfer (1 negative)
In % of IUTs were for PTL
59% were discharged home still pregnant
FFN in 76.5% prior to transfer ( 3 negative)

12. Pre-Term Premature Rupture of Membranes
29.5% of IUTs in 2011
Gestation 24 – 35 weeks
10 (84%) women gave birth
1 neonatal death 26 weeks
1 Woman transferred to another unit
1 woman discharged home
05/12/2018

13. IUGR 2011 10 (23%) IUTs for IUGR, previously <10%
Gestation weeks
9 (90%) Delivered by LSCS
1 crash CS on arrival
1 set of triplets, 2 of twins (1 MC with IUD)
2 died
05/12/2018

14. Steroids & Tocolytics 2009-11
Steroids were commenced in all cases except one in 2009 (24 weeks gestation) before transfer and the course completed before delivery where possible
Tocolysis was commenced for the transfer & continued where indicated
Atosiban is the main tocolytic used
Nifedipine used by some units

15. IUT > 34 weeks 2 at 34 +2 35 weeks IUGR. LSCS 1.49 kg baby to NNU
IUGR took own discharge
PTL, negative FFN, discharged still pregnant
35 weeks IUGR. LSCS 1.49 kg baby to NNU
2 >35 weeks PPROM kg babies NNU care not required
36+2 IUGR, hydrops. LSCS. 2.3 kg baby, NNU, NND

16. Trends in number of Transfers and Births UHNS

17. UHNS Transferring Units (n)

18. UHNS Threatened Pre-term Labour
In % of IUTs were for PTL
1 Delivered
2 outcome not documented
67% were discharged home still pregnant
FFN in 78% prior to transfer ( 0 negative)
55% had tocolysis, all Atosiban
All had steroids

19. Indication for IUT (n)
05/12/2018

20. UHNS 2011 - summary 24 IUT in 13 IUT out 24 to <33 weeks gestation
11 (46%) delivered
All received steroids
13 IUT out
27 – 36 weeks gestation

21. Capacity 2011 Local Determined by level of care required
51.5% of IUTs were within the SSBC network
97% were within network or an adjacent network
Determined by level of care required
13 IUT out from UHNS, 5 from RWHT
13 IUTs from other NNU (level 3) Trusts
At least 33% were due to capacity issues

22. Summary Local (within network/adjacent network)
97% of IUTs were local compared with 82% in 2007
Determined by level of care required
33% determined by capacity compared to 53% in 2007
Necessary transfers maximised
55 % of IUTs resulted in a birth compared with 46% in 2007

23. Summary Were unnecessary transfers minimised Fetal Fibronectin
62% of women in threatened PTL were discharged compared with 74% in 2007
Fetal Fibronectin
performed or not applicable in 77% . 3 IUTs still occurred despite negative test. One delivered
IUTs >34 weeks
6 IUTs into RWHT (2 appropriate)
3 IUTs out of UHNS

24. Recommendations
Do not transfer where FFN is negative in threatened PTL (abdominal pain without APH)
Consider not transferring out above 34 weeks unless other indications such as IUGR
NN transport service available
05/12/2018

25. Recommendations for the future
Audit to be continued & full completion of form encouraged
Other units encouraged to participate
Exception reporting audit to be added
Compare findings with NN Transport audit
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