Influence of perinatal care regionalisation on the referral patterns of intermediate- and high-risk pregnancies

• Published in: European Journal of Obstetrics & Gynecology and Reproductive Biology 2005-06, Vol.120 (2), p.152-157
• Main Authors: Pasquier, Jean-Charles, Rabilloud, Muriel, Janody, Géraldine, Abbas-Chorfa, Fatima, Ecochard, René, Mellier, Georges
• Format: Article
• Language: English
• Subjects: Antenatal referrals; Biological and medical sciences; Birth Rate; Birth Weight; Community care networks; Delivery site; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Female; France; Gynecology. Andrology. Obstetrics; Humans; Intensive Care, Neonatal - statistics & numerical data; Life Sciences; Low birth weights; Medical sciences; Other; Perinatal Care - statistics & numerical data; Perinatal regionalisation; Practice Patterns, Physicians; Pregnancy; Pregnancy, High-Risk; Pregnancy. Fetus. Placenta; Referral and Consultation - statistics & numerical data
• ISSN: 0301-2115; 1872-7654; 2590-1613
• DOI: 10.1016/j.ejogrb.2004.09.003

To use the delivery site according to the birth weight as a marker of changes in the referral practices after regionalisation of perinatal care. Analysis of the distribution of low birth weight infants according to the level of care in Rhône-Alpes from 1998 to 2000 and analysis of the birth rate heterogeneity according to the delivery site characteristics. The distribution of infants ≤1500 g remained constant at all levels (60% at level 3). That of infants 1500–2000 g born at level 3 dropped in 2000 but raised at levels 1 and 2. For both weight categories, the lower birth rates corresponded to the private, the lower-flow, and the more distant from neonatal intensive care units facilities. For infants ≤1500 g, the level 3 birth rate was four times the level 2 ( P = 0.0006) and five times the level 1 ( P < 0.0001) rates. For infants 1500–2000 g, level 3 birth rate was twice the level 2 ( P = 0.0096) and 3.6 times the level 1 ( P < 0.0001) rates. Birth rates were always significantly higher in university than in private facilities. Supervising level 3 is insufficient to show the effect of regionalisation. A more accurate analysis of intermediate-risk referral determinants is needed to reach a more demand/supply adequacy.