Maternal morbidity and pregnancy outcome in a cohort of mothers transferred out of perinatal centres during a national census.

Objective: To record the maternal morbidity and pregnancy outcome in this cohort.

Design: Retrospective data collection from a prospectively defined cohort.

Setting: The 37 largest perinatal centres in the UK.

Population: 258 in utero transfers recorded during a three-month census (1/4/99-30/6/99).

Methods: A questionnaire regarding the outcome of each mother was sent to the perinatal centre and receiving hospital.

Results: Data were returned on 242/258 (94%) mothers. Fifty-eight percent were transferred out of their perinatal centre in preterm labour and 38% had coexisting disease necessitating early delivery. The median gestational age at transfer was 32 weeks (range 23-41). Sixty-one percent delivered at the receiving hospital; 12% were transferred on to a third hospital and 29% ultimately returned to deliver at the original perinatal centre. Fifty-two percent of mothers received postnatal care in hospitals other than those defined as a major perinatal centre. One mother delivered during transfer and a further nine within one hour of arrival. One mother received intensive care after delivery and later died, a further 7% required high dependency care postnatally. Data were available on 273/333 (82%) babies. The median gestational age at delivery was 34 weeks (range 24-41). Six infants were stillborn and 187/264 (71%) infants were admitted to a neonatal unit.

Conclusions: This study has documented the maternal morbidity, potential risks and pregnancy outcome of a cohort of mothers transferred out of the largest perinatal centres in the UK because of a shortage of neonatal cots. A national standard for the delivery of high risk perinatal services is needed to uphold good clinical practice guidelines in the care of high risk mothers and their infants.