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Inter-facility maternal transport

Inter-facility maternal transport
Literature review current through: Jan 2024.
This topic last updated: Jun 08, 2022.

INTRODUCTION — Timely transfer of the complicated pregnant or postpartum patient to a facility with appropriate medical, surgical, obstetric, or pediatric resources by appropriately trained and equipped emergency medical services can reduce maternal, fetal, and/or neonatal morbidity and mortality [1,2]. The most common reason for maternal transfer is lack of availability of neonatal tertiary care, since transferring the fetus in utero is generally preferable to postnatal newborn transport.

Maternal transfers are also performed for maternal medical or surgical conditions, to accommodate family request, to comply with insurance contract requirements, or when a pregnant or postpartum patient seeks emergency care at a facility without obstetric services. The number of hospitals without obstetric services is increasing in the United States, which has led to the need for more maternal transfers, more births in hospitals without obstetric units, more preterm births, and more out-of-hospital births [3].

Disparities also exist between the levels of available maternal and neonatal services: 13 percent of females of reproductive age do not live within a 50-mile radius of an obstetric and neonatal intensive care unit [4].

This topic will discuss inter-facility maternal transport. Prehospital pediatric care and transport are reviewed separately. (See "Pediatric considerations in prehospital care" and "Prehospital pediatrics and emergency medical services (EMS)".)

BACKGROUND — In the United States, a large proportion of infant mortality and severe morbidity occurs among very low birth weight infants (VLBW, <1500 g), even though they account for only 1.3 percent of all births [5]. In part for this reason, four major organizations worked together to make recommendations for regional development of perinatal health services and maternal transport programs [6]. Two major purposes of regionalization were to clearly define the scope of neonatal care available at hospitals and increase the number of high-risk and preterm births occurring at appropriate level facilities, rather than transferring neonates to these facilities after birth.

Although most maternal transports are for neonatal indications, some are for maternal indications. A national effort to standardize maternal levels of care has also been initiated in an effort to improve maternal morbidity and mortality and decrease "near misses" [2,7]. The American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and others have developed a joint care consensus document of standards for designations of maternal care that are complementary to, but distinct from, neonatal levels of care [8,9]. Levels of maternal care are categorized as birth centers, basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV) (table 1). The document recommends that all facilities have the capacity to stabilize and provide initial care for pregnant people with emergencies (eg, hemorrhage, hypertension) and should develop collaborative relationships with higher level care facilities to facilitate maternal transport when appropriate.

Additional resources are listed below. (See 'Resources' below.)

REGULATIONS — Although all hospitals are not expected to provide labor and delivery services or tertiary maternal and neonatal care, all hospitals with emergency departments should be prepared to begin the assessment and stabilization of pregnant and postpartum patients who present for emergency care, and those offering labor and delivery services should be prepared to assess and stabilize patients who have complicated pregnancies, even if specialized care for high-risk pregnancies or complicated newborns is not available at their facility.

Emergency Medical Treatment and Labor Act (EMTALA) — The Emergency Medical Treatment and Labor Act (EMTALA) governs the transfer of patients between hospitals that accept payments from the Department of Health and Human Services, Centers for Medicare and Medicaid Services. The intent is to ensure that all patients receive a medical screening examination to determine whether an emergency medical condition exists and, if present, necessary stabilizing treatment regardless of the patient's ability to pay. Transfer of patients with an emergency medical condition is appropriate if the patient makes a written request or if the facility does not have the capability or capacity to provide necessary treatment to stabilize the emergency medical condition.

Under the statute, a pregnant patient with an emergency obstetric condition (eg, nonreassuring fetal status, advanced labor, pregnancy complications threatening maternal or fetal health) who presents to a hospital providing obstetric services is not considered stabilized until delivery of the infant and placenta. Such patients can only be transferred if they or their representative requests transfer or if a physician or other qualified medical personnel signs a certification that the benefits of transfer outweigh the risks [10]. If the hospital does not provide obstetric services, the benefits of a transfer in this setting may outweigh the risks.

A qualified medical provider may sign the certification that benefits of transfer outweigh the risks, in consultation with a physician, if the responsible physician is not physically present at the time of transfer. Hospitals have the ability to designate nonphysician medical providers to act as a qualified medical provider and provide medical screening examinations. If nonphysicians will be screening patients, the hospital must indicate in their bylaws which nonphysicians can perform this service; the written statute is not specific regarding whether the nonphysician is a registered nurse, nurse practitioner, or certified nurse midwife. A clear process for phone consultation between the physician and nonphysician provider and guidelines for when the physician must come in to assess the patient before transfer should be established. When a nonphysician certifies the transfer, hospital bylaws should provide a means for a physician to sign the certification for transfer after the fact.

Violations of the EMTALA statute may result in fines for hospitals and individual physicians, as well as termination of Medicare provider agreements or civil suits [11].

It is also important to note that patients in early labor who can be transferred to another facility without jeopardizing their health or fetal well-being are not considered to have an emergency condition covered by the statute. If the transfer is not medically necessary, the patient may be responsible for the transfer cost [12].

Commission on Accreditation of Medical Transport Systems (CAMTS) — The Commission on Accreditation of Medical Transport Systems (CAMTS) is a voluntary accreditation program for medical transport services, including rotorwing (helicopter), fixed wing (plane), and surface vehicle (ambulance, boat, etc), and is not specific to maternal transport. CAMTS has developed accreditation standards with measurable criteria for medical transport that are designed to address issues of patient care and safety. Accreditation is granted after completion of an application process and a site visit to evaluate "substantial compliance" with the accreditation standards [13].

The CAMTS accreditation process addresses multiple general criteria for certification, including:

Management and staffing

Quality management

Patient care

Communications

Rotorwing standards

Fixed wing standards

Surface vehicle standards

Medical escort standards

INDICATIONS AND CONTRAINDICATIONS

Indications — The primary indication for transport of a pregnant or postpartum patient from their present facility is lack of sufficient resources at the facility for appropriate maternal and/or neonatal care. Patients may also request transfer to another facility for personal reasons. Compliance with insurance contract requirements may also be a factor.

Maternal transfer for neonatal indications (ie, the neonate rather than the mother will require the higher level of medical care) is generally preferable to transferring the neonate after delivery. In utero transfer, when warranted and feasible, results in better infant outcomes than postnatal transfer [14-18]. It also avoids potential separation of the mother from her newborn and the newborn's health care team, which is important if a higher level of neonatal care is the reason for the transfer. (See "Preterm birth: Definitions of prematurity, epidemiology, and risk factors for infant mortality", section on 'Level of neonatal care'.)

Barriers — A potential barrier to indicated transfer is the erroneous perception among providers and/or patients that the present facility can provide an appropriate level of maternal and neonatal care. Financial disincentives may also play a role [19].

Contraindications — Maternal transport may not be possible or advisable in the following situations:

Lack of an appropriate modality for safe maternal and neonatal transfer

Weather and road conditions too hazardous for safe travel

Maternal condition insufficiently stabilized (eg, persistent hemorrhage, refractory hypertension)

Delivery is anticipated before transport completed

Unstable fetal condition threatening to deteriorate rapidly (delay in delivery would result in death or damage to the fetus)

Patient declines transfer

PLANNING AND LOGISTICS — The transferring and receiving facilities each bear responsibilities in the transfer process. Both should have an understanding of, and operate within, all applicable local and state regulations and federal statutes.

Key components

Providers at the transferring facility should initiate stabilization and treatment efforts prior to transport. The screening examination should include ongoing evaluation of fetal heart rate; frequency, strength, and duration of uterine contractions; fetal position and station; cervical dilation; and status of the membranes [20]. All patients should have intravenous (IV) access with at least an 18 gauge catheter (if possible), and oral intake should not be permitted. Placement of a bladder catheter should be considered, depending on the patient's condition (eg, ability to use a bedpan, need for information on hourly urine output) and anticipated duration of transport.

Inter-facility agreements should be in place that formalize the relationship between the transferring and receiving facilities and clearly delineate each facility's responsibilities. The service must be available 24 hours/day.

Formal protocols for all aspects of the transfer process should be developed at both the transferring and receiving facilities. Several resources are available to help create forms, checklists, and protocols. (See 'Resources' below.)

The receiving facility should be able to provide the appropriate level of care for both the mother and the newborn. Definitions for various maternal and newborn levels of care have been developed by the American College of Obstetricians and Gynecologists [21] and the American Academy of Pediatrics [22].

Good communication between the referring facility, transport team, and receiving facility is important: written documentation or, ideally, recorded conversation with typed transcript. Faulty communication related to inaccurate, incomplete, untimely, or misinterpreted verbal/written information is a leading cause of preventable serious patient harm.

An appropriately equipped, rapid mode of transport to the receiving facility should be available.

The transport team should be able to provide a timely response and should have the training and experience to assess the patient's status, determine appropriateness of transfer, and provide appropriate monitoring and care during transport. Most transport teams do not include a physician. If the transport team is not able to manage the medical issues in transport with phone consultation, then suitability for transport should be reconsidered or a physician should join the team.

Evaluation and stabilization — The first step before initiating transfer is to determine whether the mother and fetus are stable, and whether any contraindications to transfer exist (see 'Contraindications' above). According to the Emergency Medical Treatment and Labor Act (EMTALA), stability for transfer is determined by the physician or qualified medical provider evaluating the patient. (See 'Emergency Medical Treatment and Labor Act (EMTALA)' above.)

Stability is a judgment that the patient's condition is not expected to deteriorate substantially during the transfer process. If the patient is unstable, stabilizing measures should be initiated before transfer. If an unstable patient must be transferred, the transferring provider should document why the benefits of transfer to another facility outweigh the risks for the mother and/or the fetus. For example, a postpartum patient may require emergency neurologic care for an intracranial hemorrhage that occurred at a facility unable to provide those services.

Advanced labor is considered an unstable condition because of the possibility of delivery during transport. Although delivery of the obstetric patient during transport is a significant concern, the available data suggest that delivery en route is a rare event. In one large study, 1080 obstetric transports for preterm labor were performed in nulliparous and multiparous patients during a 21-month period [23]. Fifty-four patients were >7 cm dilation at the time of the call for transport, and 25 of the 54 were fully dilated; station ranged from -2 (12 patients) to +2 (10 patients). A trained flight nurse evaluated each patient at the referring facility to determine safety of transport, and decided not to transport 5 of the 54 patients. Of the remaining 49 patients, 40 were transported by helicopter with a mean transport time of 15 minutes, 8 were transported by fixed wing transport with a mean travel time of 90 minutes, and 1 was transported by ground ambulance with a transport time of 27 minutes. No patient delivered en route, but 32 (59 percent) delivered within 0 to 120 minutes of arrival at the receiving hospital.

Records and documentation — Written informed consent should be obtained and a copy of the patient's medical records (eg, antenatal record, pertinent hospital records and ultrasound reports) should accompany her to the receiving facility. Reports that are unavailable at the time of transport can be sent electronically (secure fax or email) when they become available. Completion of a transfer form that includes key information about the patient, the indication for transport, and mode of transport selected is also recommended.

Communication before and after transfer — Ongoing communication between providers at each facility are important to facilitate safe transfer. Once the decision to transfer has been made, the transferring facility (physician or provider performing the medical screening examination) should contact the receiving facility. The receiving facility should clearly communicate its willingness to accept the patient in transport. Nurse-to-nurse sign out is also essential. Key points the transferring provider should communicate include:

Gestational age

Diagnosis

Reason(s) for transfer

Patient condition (ie, vital signs, cervical examination, membrane status, fetal heart rate pattern, uterine contractions, pertinent laboratory and ultrasound results)

Intended mode of transport

Medications

Estimated blood loss and blood products transfused

Medical/obstetric history

After the patient has been transferred, the receiving facility should provide follow-up regarding the patient, as well as a written discharge summary with recommendations for outpatient care upon discharge. The process for communicating this information to the transferring facility/provider, and the person responsible for this communication (eg, receiving physician) should be clearly defined.

Responsibility — The referring physician and hospital are responsible for the patient until they arrive at the receiving facility, unless the receiving facility is sending the transport team. In that instance, the receiving facility assumes responsibility for the patient once they leave the transferring hospital. Each facility should have a clear understanding of its responsibilities before, during, and after the transport, ideally in the form of contracts, memorandum of understanding, or another written document clarifying roles and responsibilities. Medical direction during transport may be provided by the referring physician, accepting physician, medical director of the transport agency, or a combination [12].

Estimated time for and mode of transport — In determining the mode of transport, the referring provider must take into consideration a variety of factors, including availability of different modes of transport, patient acuity, weather, distance, time, ground conditions, and cost. Utilizing fixed wing and helicopter transport obviously requires additional resources, particularly take-off and landing sites. Fixed wing (and sometimes helicopter) transport also involves additional transfer of the patient by ground ambulance from the landing site to the hospital facility.

Limited observational data are available regarding advantages and disadvantages of various transport modes for obstetric patients. Air medical transport of pregnant patients by helicopter or fixed wing plane appears to be safe and associated with a very low risk of in-flight complication(s), including delivery [23-28].

Helicopter transport offers some advantages compared with surface vehicle transport, particularly when the distance to the receiving facility is relatively long or in urban areas where traffic congestion prevents rapid transit. In these situations, some patients who are considered insufficiently stable for surface vehicle transport may be candidates for more rapid transfer by helicopter. Helicopter transport costs can be competitive with ground transport costs [29]. Helicopter transport may be particularly advantageous in clinical scenarios where timely transport is essential; for example, a pregnancy at the limit of viability in advanced preterm labor where delivery at a facility unprepared to handle resuscitation of a periviable fetus may substantially impact likelihood of neonatal survival. In some situations, however, helicopter transport may limit physical access to the patient, which must be considered when assessing the safest mode for transport.

Equipment and supplies — Equipment needed for transport will depend on the type of transport, patient acuity, the type of vehicle utilized, and the distance between facilities. The minimum general equipment required should be that needed to assess maternal vital signs and perform resuscitation if indicated, including acute airway management, availability of portable oxygen tanks, and necessary equipment for their use [30].

As an example, the following specific items for maternal air or ground transport are advised by the Arizona Department of Health Services Maternal and Newborn Transport Services Policy and Procedure Manual [31]:

External fetal heart tracing monitor (or intermittent documentation of fetal heart tones by Doppler)

Advanced cardiac life support required equipment and supplies

Emergency delivery supplies

Tocolytic and antihypertensive medications

Intravenous infusion pumps with a minimum three line capability

Neonatal resuscitation equipment and supplies

Pulse oximeter

Blood pressure measurement device

More detailed information is beyond the scope of this topic, but other resources for detailed information are available elsewhere. (See 'Resources' below.)

Transport team personnel — The skills of the team should be sufficient to provide for the medical needs of the patient. Composition of the maternal transport team has not been standardized nationally. Team composition is somewhat limited by the physical capacity of the transport vehicle; therefore, the team members should have a spectrum of advanced skill sets and experience.

The Arizona Department of Health Services Maternal and Newborn Transport Services Policy and Procedure Manual provides a good example of the composition and training of a maternal transport team; specific details are available online [31]. Other resources for detailed information are available elsewhere. (See 'Resources' below.)

Monitoring and care during transport — Ongoing assessment and documentation of the maternal and fetal condition is an important component of a safe transport. Maternal vital signs should be obtained and recorded every 15 minutes, or more frequently, as dictated by the patient's condition. The frequency of uterine contractions should be noted and documented. The patient should generally be transported in a left lateral decubitus or sitting position to minimize aortocaval compression from the uterus.

Patients may develop nausea, vomiting, and/or anxiety related to the transport. Supportive care should be provided. Intravenous (IV) medication options to treat nausea and vomiting include promethazine 12.5 to 25 mg, metoclopramide 5 to 10 mg, or ondansetron 4 to 8 mg. Lorazepam 1 to 2 mg may be used alone or in combination with an antiemetic for patients with more significant anxiety issues.

The ability to perform en route continuous electronic fetal heart rate monitoring can be limited by available space for the monitor, early gestational age, and turbulence or movement from the transport process. The desired type and frequency of fetal monitoring should be discussed by the sending, receiving, and transporting teams as necessary, especially when fetus is considered viable. Intermittent documentation of fetal heart tones by Doppler should be performed if continuous fetal monitoring cannot be accomplished and is an acceptable alternative. Possible interventions if a nonreassuring fetal heart rate pattern is identified en route include repositioning the patient, increasing IV fluid administration, administering tocolytic drugs, and possibly administering supplemental oxygen. (See "Intrapartum category I, II, and III fetal heart rate tracings: Management".)

Limited data exist regarding fetal monitoring during maternal transport. In the only study on the feasibility of continuous electronic fetal heart rate monitoring during maternal fixed wing transport, 40 of the 57 transports (70 percent) were electronically monitored [32]. The other 17 patients could not be monitored electronically because of obesity, no electronic monitor available, unable to convert monitor for use with an airplane battery, or "unknown" reasons; the fetal heart rate of these patients was intermittently monitored with a Doppler device. Thirty-three of the 40 electronic fetal heart rate tracings (83 percent) were clear and readable at least 50 percent of the time en route. Maternal inspired oxygen was adequate to avoid fetal hypoxia at cabin altitudes of 1100 to 7000 feet (335 to 2134 meters) for flights up to 80 minutes long.

RESOURCES

A general guide for inter-facility patient transfer has been published by the National Highway Traffic Safety Administration. However, this guide does not specifically address pregnant patients.

Detailed information on maternal and neonatal transport is available in the chapter Maternal and neonatal interhospital transfer from Guidelines for Perinatal Care, 8th ed, Kilpatrick SJ, Papile L (Eds), American Academy of Pediatrics and American College of Obstetricians and Gynecologists, 2017, p.113.

The Society of Obstetricians and Gynecologists of Canada has published a Maternal Transport Policy statement and position paper on Rural Maternity Care [33], which also discusses relevant issues in detail.

The American College of Obstetricians and Gynecologists has published a committee opinion with information specifically related to inter-facility maternal care issues in the event of a disaster [34].

The Society for Maternal-Fetal Medicine has published a briefing form of the key elements that need to be communicated for every maternal transport, as well as practical suggestions to help facilities customize the form and implement it on their units [35].

The Joint Commission has published alerts and tools for senders and receivers of hand-off communication [36,37].

The Centers for Disease Control and Prevention (CDC) launched the voluntary Levels of Care Assessment Tool () to help states and other jurisdictions create standards for assessing maternal and neonatal levels of care.

KEY INTERVENTIONS IN SELECTED CLINICAL SETTINGS — The following outlines provide a synopsis of our approach to maternal assessment and preparation for transfer in some common clinical settings.

Preterm labor

In all patients:

Obtain maternal vital signs and assess fetal status

Perform a vaginal examination if intact membranes and no contraindications (ie, placenta previa)

Determine fetal presentation

Check urinalysis (sterile catheterized specimen preferred)

Obtain Group B Streptococcus (GBS) culture and initiate GBS prophylaxis (see "Prevention of early-onset group B streptococcal disease in neonates")

In patients with standard clinical indications:

Test for fetal fibronectin (see "Preterm labor: Clinical findings, diagnostic evaluation, and initial treatment", section on 'Fetal fibronectin for selected patients')

Screen for gonorrhea and chlamydia (see "Prenatal care: Second and third trimesters", section on 'Screen for sexually transmitted infections')

Administer magnesium sulfate for fetal neuroprotection (see "Neuroprotective effects of in utero exposure to magnesium sulfate", section on 'Candidates for treatment')

Administer tocolysis (see "Inhibition of acute preterm labor", section on 'Patient selection')

Administer betamethasone 12 mg intramuscular (IM) or dexamethasone 6 mg IM prior to transport (see "Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery", section on 'Candidates for a first ACS course by gestational age')

Preterm prelabor rupture of membranes

In all patients:

Obtain maternal vital signs and assess fetal status

Confirm diagnosis (see "Preterm prelabor rupture of membranes: Clinical manifestations and diagnosis", section on 'Diagnostic evaluation and diagnosis')

Determine fetal presentation

Do not perform digital vaginal examination unless clinically indicated; if delivery is not believed to be imminent, a speculum to assess cervical dilation is usually sufficient

Assess for clinical evidence of chorioamnionitis (eg, fever, fetal tachycardia, maternal leukocytosis) (see "Clinical chorioamnionitis", section on 'Diagnosis')

In patients with standard clinical indications:

Initiate intravenous (IV) antibiotics for prophylaxis or treatment

Administer tocolysis

Administer betamethasone 12 mg IM or dexamethasone 6 mg IM (see "Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery", section on 'Candidates for a first ACS course by gestational age')

Administer magnesium sulfate for fetal neuroprotection (see "Neuroprotective effects of in utero exposure to magnesium sulfate", section on 'Candidates for treatment')

Third-trimester vaginal bleeding — The most common causes of third-trimester vaginal bleeding include placenta previa, abruption, trauma, and labor. (See "Evaluation and differential diagnosis of vaginal bleeding after 20 weeks of gestation", section on 'Placental abruption'.)

Obtain maternal vital signs and assess fetal status

Do not perform a vaginal examination until placenta previa has been ruled out by ultrasound (see "Placenta previa: Management")

Determine fetal presentation

Determine likely cause of bleeding

Estimate total blood loss and potential for on-going hemorrhage

Check maternal hemoglobin and hematocrit

Document any blood products transfused

Maintain more than one IV site (one with 16 gauge catheter, if possible)

Place a bladder catheter to monitor urine output

Administer magnesium sulfate for fetal neuroprotection if clinically indicated (see "Neuroprotective effects of in utero exposure to magnesium sulfate")

Administer tocolysis if clinically indicated (see "Acute placental abruption: Management and long-term prognosis", section on 'Subsequent management' and "Placenta previa: Management", section on 'Tocolysis')

Administer betamethasone 12 mg IM or dexamethasone 6 mg IM if clinically indicated (see "Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery", section on 'Candidates for a first ACS course by gestational age')

Pregnancy-related hypertensive disorders

Assess maternal symptoms of headache, visual changes, epigastric pain, nausea and vomiting

Obtain maternal vital signs and assess fetal status

Administer a loading dose of magnesium sulfate prior to transport (see "Eclampsia" and "Preeclampsia: Intrapartum and postpartum management and long-term prognosis", section on 'Seizure prophylaxis')

Place a bladder catheter and monitor intake and output to avoid excessive fluid administration (see "Preeclampsia: Intrapartum and postpartum management and long-term prognosis", section on 'Fluids')

Provide supplemental oxygen as needed to maintain O2 saturation ≥95 percent

Perform laboratory evaluation for transaminases (aspartate transaminase, alanine transaminase), platelet count, hemoglobin, hematocrit, creatinine, and proteinuria (see "Preeclampsia: Clinical features and diagnosis")

Document reflexes, edema, visual acuity

Institute seizure precautions

Assess for signs and symptoms of features of severe disease (table 2)

Administer antihypertensive medications if hypertension is severe

Manage seizure activity (see "Eclampsia", section on 'Management')

QUALITY INDICATORS — Maternal transport programs (both the sending and receiving facilities) should monitor processes, outcomes, and adverse events as part of a continuing quality assurance process. The Society for Maternal-Fetal Medicine has suggested consideration of the following five quality indicators [35]:

A detailed review of any case involving delivery en route, delivery within 15 minutes after arrival, or deterioration of maternal condition requiring diversion to another facility.

A formal periodic review of maternal transports for each referring institution, including frequency of any requested transfers that were declined and the reasons for declining.

Standard clinical management guidelines for the most common indications for maternal transport (eg, preterm labor, preterm prelabor rupture of membranes, hypertensive disorders) developed by the receiving hospital and shared with all the referring hospitals in the region.

Tracking of measures of the efficiency of transport (eg, time from initial transport request to arrival at receiving hospital, time from initial request to formal acceptance of transfer) and appropriateness of transport.

A specified process to update referring physicians and prenatal care professionals on the outcome or condition of the patient who was transported.

SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: General prenatal care".)

SUMMARY AND RECOMMENDATIONS

Indications and contraindications – Maternal transport should be considered if the facility does not have sufficient resources to meet maternal and/or neonatal medical needs, and there is low probability for clinical deterioration of mother and fetus during transport. (See 'Indications and contraindications' above.)

Outcomes for preterm neonates are improved if delivery occurs at an appropriate level facility versus neonatal transport to the appropriate facility. (See 'Background' above.)

Planning and logistics – (See 'Planning and logistics' above.)

The maternal transport should be coordinated between the transferring and receiving facility and the patient accompanied by appropriately trained medical personnel. Good communication between the referring facility, transport team, and receiving facility is important.

Providers at the transferring facility should initiate stabilization and treatment efforts prior to transport. The receiving facility should be able to provide the appropriate level of care for both the mother and the newborn.

Formal protocols for all aspects of the transfer process should be developed at both the transferring and receiving facilities. Several resources are available to help create forms, checklists, and protocols. (See 'Resources' above.)

Regulations – An understanding of, and compliance with, the Emergency Medical Treatment and Labor Act guidelines and relevant state statutes is essential when transporting patients. (See 'Regulations' above.)

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  31. http://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/high-risk/complete-transport-manual.pdf (Accessed on March 13, 2018).
  32. Elliott JP, Trujillo R. Fetal monitoring during emergency obstetric transport. Am J Obstet Gynecol 1987; 157:245.
  33. No. 282-Rural Maternity Care https://www.jogc.com/article/S1701-2163(17)31054-X/abstract.
  34. Committee Opinion No. 726: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care. Obstet Gynecol 2017; 130:e291. Reaffirmed 2022.
  35. Patient Safety and Quality Committee, Society for Maternal-Fetal Medicine. Electronic address: [email protected], Gibson KS, McLean D. Society for Maternal-Fetal Medicine Special Statement: A maternal transport briefing form and checklist. Am J Obstet Gynecol 2020; 223:B12.
  36. The Joint Commission. Sentinel Event Alert. Inadequate hand-off communication.
  37. The Joint Commission Center for Transforming Healthcare’s Targeted Solutions Tool® (TST®) for Hand-off Communications.
Topic 17178 Version 34.0

References

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