Organisation of obstetric services for very preterm births in Europe: results from the MOSAIC project

Abstract

Objective To study the impact of the organisation of obstetric services on the regionalisation of care for very preterm births.Design Cohort study.Setting Ten European regions covering 490 000 live births.Population All children born in 2003 between 24 and 31 weeks of gestation.Method The rate of specialised maternity units per 10 000 total births, the proportion of total births in specialised units and the proportion of very preterm births by referral status in specialised units were compared.Main outcome measure Birth in a specialised maternity unit (level III unit or unit with a large neonatal unit (at least 50 annual very preterm admissions).Results The organisation of obstetric care varied in these regions with respect to the supply of level III units (from 2.3 per 10 000 births in the Portuguese region to 0.2 in the Polish region), their characteristics (annual number of deliveries, 24 hour presence of a trained obstetrician) and the proportion of all births (term and preterm) that occur in these units. The proportion of very preterm births in level III units ranged from 93 to 63% in the regions. Different approaches were used to obtain a high level of regionalisation: high proportions of total deliveries in specialised units, high proportions of in utero transfers or high proportions of high-risk women who were referred to a specialised unit during pregnancy.Conclusion Consensus does not exist on the optimal characteristics of specialised units but regionalisation may be achieved in different models of organisation of obstetric services.

A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study

“…Outcomes for extremely premature infants are improved for those infants born in hospitals with high-volume specialist neonatal care units. 19 Blondel et al 62 reported that in 2003, across a range of European regions, 2-28% of birth units were associated with a 'large neonatal unit' (≥ 50 admissions per year for infants with a gestational age of < 32 weeks). Between 8% and 61% of all births were in hospitals with large neonatal units, but 37-76% of births of infants with a gestational age of < 32 weeks were achieved in such units (20-54% of births of infants with a gestational age of < 32 weeks were achieved in such units without requiring in utero transfer).…”

“…There are three general models for trying to achieve births of preterm infants in units with large neonatal units (and these models may be mixed): (1) consolidation of births into higher-volume units that may sustain a large neonatal unit, (2) identifying mothers at a high risk of preterm delivery and booking those mothers to deliver in high-volume neonatal units and (3) in utero transfer during labour. Blondel et al 62 noted that different European regions were achieving reasonable rates of birth of premature infants in units with large neonatal units by using different organisational models; however, there was still a significant proportion of births (24-63%) of premature infants not occurring in units with large neonatal units.…”

“…Increased consolidation of childbirth could increase the proportion of preterm births in units with large neonatal units (especially if the large neonatal units were optimally located to be better matched to demand). But, as Blondel et al 62 noted, organisation of services around these high-risk births may not be acceptable to the larger population of low-risk mothers whose infants will not require any specialist obstetric neonatal care, and for whom birth is not a medical procedure.…”

Analysis of Work of Perinatal Centers in Nursing of Preterm Infants in Ukraine

“…Ключовою проблемою зменшення перинатальних втрат є створення можливостей для виходжування дітей з дуже малою масою тіла при народженні, адже саме з ними пов'язана приблизно половина всіх випадків перинатальних втрат. того, діти, що народилися з дуже малою масою тіла, складають групу ризику щодо розвитку захворювань, що формують показники інвалідності [11,13,15].…”

“…За даними ВООЗ у економічно розвинених країнах виживання новонароджених у перші 168 годин життя з масою тіла при народженні 500 -999 г складає 30,0%, а новонароджених з масою тіла при народженні 1000 -1499 г -70,0% [4,12,13]. Виживання дітей з дуже малою масою тіла при народженні в США, Японії і більшості країн Західної Європи досягло 80 і 95% відповідно [7,11,15].…”