Pre-term pathway for Clyde Maternity Triage

Maternity & Gynaecology Guidelines
NHS GGC

Objectives

Direct access to QEUH/RHC for pregnant women in RAH catchment area who are reporting symptoms of imminent pre term birth.

This pathway is for pregnancies between: 22+0-26+6 weeks for singleton / 27+6 weeks for a multiple pregnancy.

Please refer to Preterm birth (1188) GGC guideline for pre term optimisation guide.

The purpose of this pathway is to provide maternity staff working within Clyde triage a direct access pathway to the Queen Elizabeth University Hospital (QEUH) maternity services where delivery is expected to be imminent.

Optimal outcomes for extreme preterm infants is achieved by full perinatal optimisation, including delivery in a NICU (previously level 3 Neonatal Unit - NNU) adjacent to a maternity centre.  Delivery in a LNU (Local Neonatal Unit, previously level 2 NNU) with subsequent postnatal transfer is associated with poorer outcomes in this patient group.

Previously all women presenting in the Clyde area have attended the RAH for assessment initially, and then were transferred to a NICU unit for delivery, however this process can result in delivery at the RAH if in utero transfer is not possible after assessment. 

As much of the Clyde catchment area is accessible to the QEUH in a similar timescale to the RAH, direct access to the QEUH for delivery is preferred.  The following pathway describes this process.  The aim is to selectively direct those at highest risk of immediate delivery to the QEUH, while ensuring that routine antenatal reviews continue at the RAH to avoid negatively impacting on QEUH capacity. 

It is imperative that women and emergency care providers can access the QEUH maternity services:

  • When they are displaying signs of labour at or less than 26+6 weeks for a singleton pregnancy, at or before 27+6 weeks for a multiple pregnancy, or where a baby has very complex medical conditions.
  • When the estimated fetal weight is less than 800g.
  • Where active management of babies with life limiting conditions who are at or less than 27+6 weeks is expected following counselling and planning made by families and neonatal team.

Accurate predication of preterm birth is challenging and therefore subject to frequent review by senior obstetric clinicians. The majority of women with symptoms of preterm birth will not go on to give birth prematurely.

Pathway for pregnancies between 22+0-26+6 weeks singleton / 27+6 weeks multiples

If a woman or emergency care provider contacts her local triage unit with symptoms of pre term labour the following should be asked:

  • Confirmation of name/CHI
  • Contact telephone number in event of call ending unexpectedly.
  • If it is a singleton/ multiple pregnancy and gestation of pregnancy
  • Any known surgical or medical conditions affecting the baby.
  • Signs/symptoms woman is currently experiencing.

The hospital where the woman is booked to receive her pregnancy care will be responsible for ascertaining over a triage telephone consultation the anticipated likelihood of imminent birth. Information regarding severity and timing of contractions should be enquired about as well as the presence of vaginal bleeding. Risk factors for pre term birth should be enquired about by the triage call handler.

Women should be advised to attend the QEUH maternity triage department for assessment when:

  • Baby is birthed before arrival.
  • Women describe frequent uterine activity with feeling of lower abdominal or rectal pressure.
  • Confirmed ROM at <26+6 weeks with new abdominal pain or bleeding.
  • Cervical cerclage in place with new abdominal pain or bleeding.

Women between 22+0-26+6 weeks for singletons and 27+6 weeks for multiples who are requiring assessment for potential pre term labour as part of a differential diagnosis should be assessed in the hospital where they are booked to receive pregnancy care. If following assessment pre term labour is deemed likely then, where possible, women should have an in utero transfer to the QEUH.

If birth is likely to occur before arrival at the QEUH, the telephone triage operator should aim to remain on the phone to provide clinical support and guidance.

Arrangements for Remote and Rural Care Locations

The aligned hospital for remote and rural care locations in Argyll and Bute is RAH and all triaging would initially go through RAH, this may be via direct contact with the on call consultant depending on the presentation/acuity of the woman.  In situations where there is an extreme obstetric emergency pertaining to women of these gestations, the existing national guidance for remote and rural extreme obstetric emergencies should be used.  Scottish Perinatal Network Transport Group - Pathway for the Transfer of Women from Community Maternity Units in an Extreme Obstetric Emergency (this is under review).

As midwives working in remote and rural areas undertake initial triage and assessment, this will also be based on use of BSOTS (Birmingham Symptom-Specific Obstetric Triage System) algorithms going forward.

If the woman’s local maternity triage unit feels birth is imminent then they should contact the QEUH by phoning 0141 201 2345 which is the emergency number for staff. Clinical details should be given to QEUH triage staff of the woman who is being advised to attend.

QEUH maternity triage staff should ascertain if the woman should attend triage or go directly to QEUH labour suite. This will be based on an assessment of BSOTS algorithms.

Editorial Information

Last reviewed: 26/08/2025

Next review date: 31/08/2028

Author(s): Fiona Hendry.

Version: 1

Approved By: Maternity Governance Group