Risk factors for not delivering in a level III unit before 32 weeks of gestation: results from a population‐based study in Paris and surrounding districts in 2003

Abstract

Delivery of very preterm babies in maternity units with on-site neonatal intensive care (level III units) is associated with lower mortality and morbidity. This analysis explores risk factors for not delivering in a level III unit, using data from a population-based study of very preterm births in Paris and surrounding districts in 2003. The sample for analysis included resident women with a fetus alive at the onset of labour between 24 and 31 weeks of gestation (n = 641). Characteristics of women delivering in and those not in level III units were compared using logistic regression. Further analysis was carried out for the subgroup of women not already scheduled to deliver in a level III unit. Twenty-nine per cent of women did not deliver in level III units; in the subgroup scheduled to deliver in level I or II units, 43% were not transferred. Women were less likely to deliver in a level III unit if they had a singleton pregnancy, a gestation of <26 weeks or at 31 weeks, experienced antenatal haemorrhaging, lived in socially deprived neighbourhoods or at a greater distance from the nearest level III. Women scheduled to deliver in a maternity unit with a special care nursery were also less likely to deliver in a level III unit. In contrast, preterm rupture of membranes and fetal growth restriction increased the likelihood of a level III delivery. These results underline the importance of controlling for clinical characteristics when analysing perinatal outcome by place of delivery and show how socioeconomic factors, known to impact on the risk of having a preterm birth, can also affect access to appropriate care.

Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention

“…One implication of this dynamic is that women with more resources may select better equipped hospitals for their care, whether or not they need high-risk services. This is one explanation for the finding that patient characteristics and neighborhood poverty measures are associated with the rate of high-risk deliveries at hospitals with NICU (Bronstein et al 1995;Gould et al 1999;Samuelson et al 2002;Sinkin et al 2005;Zeitlin et al 2008).…”

“…Over the past two decades there has been an increase in the number of hospitals claiming to provide neonatal intensive care at some level, even if they have a relatively low volume of patients and lack full-time coverage by neonatologists (Richardson, Reed, and Cutler 1995;Goodman et al 2001;Howell et al 2002). Perinatal regionalization to tertiary settings is reduced in locales with more availability of intermediate NICU hospital settings because of shifts in obstetrics referral patterns (Powell et al 1995;Gould et al 1999;Haberland, Phibbs, and Baker 2006;Zeitlin et al 2008).…”

“…Although there have been several studies of the factors associated with delivery of preterm or low birth weight newborns in neonatal intensive care settings (Phibbs et al 1993;Bronstein et al 1995;Gould et al 1999;Samuelson et al 2002;Sinkin et al 2005;Attar et al 2006;Zeitlin et al 2008), they have not been oriented toward an explicit conceptual framework. Perinatal regionalization is a consequence of an interaction between a primary obstetrics provider and a pregnant woman needing delivery services for a high-risk newborn.…”

Les naissances des grands prématurés en dehors des maternités de type III sont-elles évitables ? Expérience du réseau Grand Lyon

“…Trois é tudes publié es en 2008 et 2009 retrouvent seulement 11,6 à 29 % de pré maturé s né s hors type III [20][21][22].…”

Levels of Neonatal Care

“…For example, race and insurance status may have more of an effect on birth outcomes in the United States [34][35][36]38 than in countries with a more homogenous population and universal national health care. 39 There are also potential confounding factors for which measurement is frequently lacking, such as parental wishes regarding aggressive resuscitation of an infant. Arad et al noted that parental wishes varied by religious affiliation in their 2-hospital study.…”