An extremely premature baby (born before 27 weeks) is more likely to survive if they are born in a hospital unit where the whole range of medical and neonatal care can be provided (a Level 3 centre).
Although this is not always possible due to the unpredictable nature of preterm delivery, high transfer rates of women with signs of premature labour can be achieved where there is consistency and cooperation between maternity units.
The Oxford PSC Maternity Clinical Network conducted an audit in April 2015, specifically looking at cases in which extremely preterm babies which were not born in a Level 3 centre. This identified barriers to transfer of the mother before delivery of the baby/babies as well as other related areas for improvement.
Using this, the Maternity Network developed and implemented across the Oxford AHSN region:
- a revised referral pathway for in utero transfers (transfer via ambulance of the pregnant woman to a Level 3 centre)
- a set of guidelines to improve the identification and management of threatened preterm labour
- a rolling audit of cases where birth occurred outside of a Level 3 centre for continued monitoring of any barriers to appropriate in utero transfer.
In a follow-up audit published in July 2016 we were able to report that the rate of extremely premature babies born in the safest place increased by 50% in the Oxford AHSN region, meaning that 75-80% of these babies are being identified and delivered in Level 3 centres. An independent study conducted by the Office of Health Economics and RAND Europe found that this project was saving the lives of four additional babies per year.