ABSTRACT
The objective of this study was to assess the indications, appropriateness, and cost
of maternal-fetal transfers to a tertiary care facility in an era of managed care.
Our perinatal database was reviewed from January 1, 1996 through June 30, 1997 to
determine maternal and fetal indications for transfer, referring institution characteristics,
utilization of tertiary level services, and cost of transfer. There were 273 transfers
from 53 referring hospitals ranging in distance from <20 miles (n = 102) to >100 miles (n = 41). Thirty-one patients were transferred by air (average cost $7656), 238 by ground
(average cost $920), 4 by private car. The referring diagnosis was preterm premature
rupture of membranes (PPROM) (n = 80), preterm labor (n = 76), preeclampsia (n = 42), medical complications (n = 25), or other (n = 50). Mean gestational age (GA) at transfer was 28.5 ± 5.5 weeks. Patients were
referred from hospitals with a self-designated nursery level I (n = 115), II (n = 111), III (n = 45), or none (n = 2). In 42 patients, (15%) no maternal or fetal indication for hospital transfer
was identified after evaluation at the tertiary center. The most common referring
misdiagnoses were preterm labor (n = 25), PPROM (n = 10) and preeclampsia (n = 3). One hundred and sixty-five patients delivered during transfer admission (mean
GA = 29.6 ± 4.8 weeks); 79 infants (48%) required admission to a level III, and 52
(31%) to a level II nursery. Most patients require the services of a tertiary facility
after maternal fetal transfer. If delivered during transfer admission, the majority
of neonates require care in an intermediate or intensive care nursery.
Keywords
Maternal transfers - regionalization
