Treatment Plan Part A―British Colombia Level of Care Needed Based on GA Needs of Newborn

GA (weeks)

Treatment Plan

<26

$

Transfer to Lever 3b High Acuity NICU

$

26 - 29+6

$

Transfer to Lever 3a High Acuity NICU

$

30 - 34+6

$

Transfer to Level 2a (32 - 34+6) or 2b (30 - 31+6) NICU

$

35 - 35+6

$

Level 1b Well Newborn Nursery at local rural centre so long as criteria under Treatment Plan Part B are met and no exclusion criteria under Treatment Plan Part C are met.

$

≥37

Level 1a Well Newborn Nursery at local rural centre so long as criteria under Treatment Plan Part B are met and no exclusion criteria under Treatment Plan Part C are met.

Treatment Plan Part B―Delivery Criteria for 36 - 40 Weeks GA Level 1 Nursery Vaginal Delivery

1) Vertex presentation

2) Caesarean section back up available on site

3) Unconcerning Foetal Growth Scan at 32 - 34 weeks GA for delivery planning

4) Unconcerning Cervical length monitoring via transvaginal ultrasound (could consider less accurate manual examination) to monitor preterm delivery risk if deemed necessary (length ≥ 25 - 30 mm is reassuring): 18 - 20 and 28 - 34 weeks GA

Treatment Plan Part C―Exclusion Criteria for 36 - 40 Weeks GA Level 1 Nursery Delivery

1) Breech presentation

2) Thick and inelastic vaginal septum

3) Intrauterine growth restriction

4) Polyhydramnios

5) Cervical incompetence if progressive