A new guidance supplement has been published by the Intensive Care Society that aims to improve the safety and quality of care when critically unwell pregnant or recently pregnant women are moved between areas within one hospital or moved to a different hospital (transfers).
It builds on existing guidance[1] and acknowledges some important additional factors that need to be considered around the time of the transfer. This is the first time that transfer guidance has been published by the Intensive Care Society relating specifically to pregnant or recently pregnant women.
Why do critically ill women need to be transferred?
There are a variety of different reasons why a pregnant or recently pregnant woman may require a transfer:
- Transfer to a different hospital to receive specialist care. This may be to access specialist obstetric or fetal care (for the baby’s wellbeing), or it may be to treat a complication that has arisen in the woman, for example a stroke (bleeding in the brain) or a heart problem. These conditions may have specific treatments that are not available in all hospitals with maternity units and may require specialist treatment in a regional or national centre.
- Some birthing and maternity units are ‘stand-alone’ units and transfer is required to access levels of care and investigations that are not available in that unit.
- Some maternity units may be in a different building to the hospital’s non-maternity services such as intensive care or departments which can treat non-obstetric problems. Although some transfers within a hospital can be made on foot, others may require an ambulance if the buildings are not connected by corridors, walkways or lifts.
How often do critically ill women need to be transferred?
Data on the transfer of critically ill women are scarce. While transfers to different hospitals are infrequent, intra-hospital (within the same hospital building) and inter-site (between two buildings of the same hospital trust) transfers are common.
What does this new guidance add?
This supplement applies to the transfer of critically ill women from 20 weeks pregnant to six weeks after birth, although many of the principles described are relevant to earlier pregnancy too. It is applicable to all types of transfer within and between hospitals.
The guidance recommends a five-stage process:
- Identify the need and urgency of transfer
- Involve the woman, birth partner and family
- Multi-disciplinary team review
- Communicate with the transfer service and teams in the receiving centre
- Manage the transfer.
The guidance is for all members of the multi-disciplinary team who may be involved in making a decision to transfer or carrying out the transfer of a woman who is pregnant, or recently pregnant.
What are the MNSI themes relating to transfer?
MNSI welcomes this new guidance. Through MNSI investigations, we have seen that harm can arise when transfers are conducted without careful consideration and planning. This has included investigations where some team members have been unaware that a transfer is taking place.
It is vital that pregnant or recently pregnant women receive at least the same level of care[2] [3] as any other critically unwell adult. When multiple teams are involved, as is often the case in a maternity transfer, the chance of miscommunication can increase. Organisations need robust processes to ensure that relevant clinical and non-clinical details are shared effectively.
References
[1] The Faculty of Intensive Care Medicine and the Intensive Care Society. (2019) Guidance on the transfer of the critically ill adult [Online]. Available at https://ics.ac.uk/resource/transfer-critically-adult.html (Accessed 11 March 2026)
[2] The Faculty of Intensive Care Medicine and the Intensive Care Society. (2026) Section 3.18 Care of the Critically Ill Pregnant (or recently pregnant) Patient. In General Provision of Intensive Care Services, Version 3. [Online]. Available at https://ics.ac.uk/guidance/gpics.html (Accessed 11 March 2026).
[3] The Faculty of Intensive Care Medicine and the Intensive Care Society. (2026) Section 3.14 Care of the Critically Ill Pregnant (or recently pregnant) Patient. In General Provision of Intensive Care Services, Version 3. [Online]. Available at https://ics.ac.uk/guidance/gpics.html (Accessed 11 March 2026).
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