National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
BMC Pregnancy Childbirth. 2013 Dec 5;13:224. doi: 10.1186/1471-2393-13-224.
In England, there is a policy of offering healthy women with straightforward pregnancies a choice of birth setting. Options may include home or a freestanding midwifery unit (FMU). Transfer rates from these settings are around 20%, and higher for nulliparous women. The duration of transfer is of interest because of the potential for delay in access to specialist care and is also of concern to women. We aimed to estimate the duration of transfer in births planned at home and in FMUs and explore the effects of distance and urgency on duration.
This was a secondary analysis of data collected in a national prospective cohort study including 27,842 'low risk' women with singleton, term, 'booked' pregnancies, planning birth in FMUs or at home in England from April 2008 to April 2010. We described transfer duration using the median and interquartile range, for all transfers and those for reasons defined as potentially urgent or non-urgent, and used cumulative distribution curves to compare transfer duration by urgency. We explored the effect of distance for transfers from FMUs and described outcomes in women giving birth within 60 minutes of transfer.
The median overall transfer time, from decision to transfer to first OU assessment, was shorter in transfers from home compared with transfers from FMUs (49 vs 60 minutes; p < 0.001). The median duration of transfers before birth for potentially urgent reasons (home 42 minutes, FMU 50 minutes) was 8-10 minutes shorter compared with transfers for non-urgent reasons. In transfers for potentially urgent reasons, the median overall transfer time from FMUs within 20 km of an OU was 47 minutes, increasing to 55 minutes from FMUs 20-40 km away and 61 minutes in more remote FMUs. In women who gave birth within 60 minutes after transfer, adverse neonatal outcomes occurred in 1-2% of transfers.
Transfers from home or FMU commonly take up to 60 minutes from decision to transfer, to first assessment in an OU, even for transfers for potentially urgent reasons. Most transfers are not urgent and emergencies and adverse outcomes are uncommon, but urgent transfer is more likely for nulliparous women.
在英国，政策为简单妊娠的健康女性提供生育环境选择。选择可能包括家庭或独立助产士单位（FMU）。从这些环境中转出的比例约为 20%，而初产妇的比例更高。中转时间是一个关注点，因为可能会延迟获得专科护理，这也是女性关心的问题。我们旨在估计在家中和 FMU 中计划分娩的分娩中转时间，并探讨距离和紧迫性对时间的影响。
这是一项对 2008 年 4 月至 2010 年 4 月在英格兰参加一项全国性前瞻性队列研究的 27842 名单胎、足月、“预订”妊娠、计划在 FMU 或家中分娩的“低风险”女性数据进行的二次分析。我们使用中位数和四分位距描述所有转移和那些被定义为潜在紧急或非紧急转移的转移持续时间，并使用累积分布曲线比较紧急程度的转移持续时间。我们探讨了 FMU 转移的距离效应，并描述了在转移后 60 分钟内分娩的女性的结果。
从决定转移到首次 OU 评估的总转移时间，家中转移的中位数比 FMU 转移的中位数更短（49 分钟比 60 分钟；p<0.001）。对于潜在紧急原因的产前转移持续时间中位数（家庭 42 分钟，FMU 50 分钟）比非紧急原因的转移持续时间中位数短 8-10 分钟。对于潜在紧急原因的转移，距离 OU 20 公里以内的 FMU 的总转移时间中位数为 47 分钟，距离 OU 20-40 公里的 FMU 的转移时间中位数增加到 55 分钟，距离更远的 FMU 的转移时间中位数增加到 61 分钟。在转移后 60 分钟内分娩的女性中，1-2%的转移出现新生儿不良结局。
从决定转移到首次 OU 评估，家中或 FMU 的转移通常需要长达 60 分钟，即使是对于潜在紧急原因的转移也是如此。大多数转移不是紧急的，紧急情况和不良结局很少见，但初产妇更有可能需要紧急转移。
