Maternal-Fetal Transport



Maternal-Fetal Transport


Judy Wilson-Griffin



Maternal transport is a fundamental component of regionalized perinatal care. Perinatal regionalization through a structured designated method guarantees that hospitals and healthcare systems provide a full range of services for pregnant women and their babies within in a specified geographic region (American Academy of Pediatrics [AAP] & American College of Obstetricians and Gynecologists, 2012). In a seminal document published in 1976, Toward Improving the Outcome of Pregnancy, the March of Dimes (MOD; 1976) proposed a model system for regionalization of perinatal care including definitions for levels of care (e.g., levels I to III) in hospitals that provided perinatal services. The goal was to promote transfer of high-risk mothers to hospitals with the appropriate level of care based on gestational age of the fetus. This model was adopted across the United States and resulted in perinatal regionalization and improved perinatal outcomes as more preterm babies and babies with high-risk conditions were born at centers that had the skilled personnel and additional resources for their stabilization and ongoing care (MOD, 1993). High-risk pregnant women also benefited by being cared for in level II and level III perinatal centers. Since the 1970s, regionalized care has proven to be a useful service that can improve both maternal and/or fetal outcome (MOD, 1993). Due to the evidence of significant improvements in outcomes for these patients when transferred appropriately when stable, in 2009, the National Quality Forum (NQF; 2009) in their National Voluntary Consensus Standards for Perinatal Care recommended using babies under 1,500 g born at a hospital with the appropriate level of care as a quality care indicator.

Neonatal transport has been active in the United States since the 1960s after the establishment of neonatal intensive care units (NICUs) (Glass, 2004). However, even with the development of well-trained neonatal transport teams, evidence has shown that in most cases, the mother proves to be the best transport vehicle for the fetus (MacDonald, 1989). Thus, maternal, instead of neonatal, transport is preferred when feasible. As with any procedure, transport has advantages and disadvantages. While there may be advantages to the health of both the mother and her unborn fetus, it can be less than ideal to have women give birth sometimes far from their home, family, and friends and without their primary obstetrician who they have become accustomed to for continued care. Indications for maternal-fetal transport are listed in Display 13-1.


EMTALA

When discussing maternal-fetal transport, it is important to review the Emergency Medical Treatment and Active Labor Act (EMTALA) regulations as they relate to appropriate transfers. EMTALA originated in 1985 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA; 1985), to protect patients during an emergency regardless of their ability to pay for care or insurance status. The law requires that all patients, including those in labor, be assessed, stabilized, and treated at the hospital where they present regardless of their ability to pay for care or insurance status. EMTALA (U.S. Department of Health and Human Services & Centers for Medicare & Medicaid Services, 2003, 2009) requires that hospitals perform a medical screening exam (MSE) for anyone who presents with an emergency medical condition (EMC). The goal for the patient who presents is to either be stabilized and treated or transferred to a facility that can better meet the medical needs of the patient based
on her individual clinical situation. Pregnant women who present with contractions and/or who may be in labor are considered unstable. Caregivers must consider many factors in their decision regarding when it is appropriate to transfer a pregnant woman to another facility. A pregnant woman who is having contractions is not considered to be having an EMC if it is determined that there is adequate time to safely transfer her before she gives birth or if the transfer will not pose a threat to the safety of the patient. Caregivers must evaluate whether the woman and her fetus will be better served at a higher level of care. This is not always a straightforward or clear clinical judgment. A woman who appears stable prior to transport may become unstable during the transport. Unanticipated birth could occur prior to arrival at the receiving facility. Transfer might also be feasible based on the patient’s request.

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May 22, 2016 | Posted by in NURSING | Comments Off on Maternal-Fetal Transport
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