Title :

Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE-2 cohort study

Author(s) :

Desplanches, T. [Auteur]
Morgan, A. S. [Auteur]
Jones, P. [Auteur]
Diguisto, C. [Auteur]
Zeitlin, J. [Auteur]
Martin-Marchand, L. [Auteur]
Benhammou, V. [Auteur]
Lecomte, B. [Auteur]
Rozé, J. C. [Auteur]
Truffert, Patrick [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Ancel, P. Y. [Auteur]
Sagot, P. [Auteur]
Roussot, A. [Auteur]
Fresson, J. [Auteur]
Blondel, B. [Auteur]

Journal title :

Paediatric and Perinatal Epidemiology

Abbreviated title :

Paediatr Perinat Epidemiol

Volume number :

35

Pages :

p. 694-705

Publication date :

2021-11

ISSN :

1365-3016

English keyword(s) :

antenatal transfer
geographical access
obstetric care
perinatal epidemiology
place of delivery
very preterm birth

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without ...
Show more >Background Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%-30% of women deliver outside these units (outborn). Objective To investigate risk factors associated with outborn deliveries and to estimate the proportion that were probably or possibly avoidable. Methods We used a national French population-based cohort including 2205 women who delivered between 24 and 30+6 weeks in 2011. We examined risk factors for outborn delivery related to medical complications, antenatal care, sociodemographic characteristics and living far from a level III unit using multivariable binomial regression. Avoidable outborn deliveries were defined by pregnancy risk (obstetric history, antenatal hospitalisation) and time available for transfer. Results 25.0% of women were initially booked in level III, 9.1% were referred, 49.8% were transferred, and 16.1% had outborn delivery. Risk factors for outborn delivery were gestational age <26 weeks (adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.13, 1.66), inadequate antenatal care (aRR 1.39, 95% CI 1.10, 1.81), placental abruption (aRR 1.66, 95% CI 1.27, 2.17), and increased distance to the closest level III unit ((aRR 2.79, 95% CI 2.00, 3.92) in the 4th versus 1st distance quartile). Among outborn deliveries, 16.7% were probably avoidable, and 25.6% possibly avoidable, which could increase the proportion of inborn deliveries between 85.9% and 92.9%. Avoidable outborn deliveries were mainly associated with gestational age, intrauterine growth restriction, preterm premature rupture of membranes, and haemorrhage, but not distance. Conclusions Our study identified some modifiable risk factors for outborn delivery; however, when regionalised care relies heavily on antenatal transfer, as it does in France, only some outborn deliveries may be prevented. Earlier referral of high-risk women will be needed to achieve full access to tertiary care.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2023-11-15T06:44:47Z
2024-04-19T12:38:05Z