In France, the organization of perinatal care has a direct influence on the outcome of the mother and the newborn: Contribution from a French nationwide study

OBJECTIVE To investigate maternal and neonatal outcomes after a delivery in France in 2019, according to hospital characteristics and the impact of distance and time of travel on mother and newborn. METHODS All parturients above 18 years of age who delivered in 2019 and were identified in the French health insurance database were included, with their newborns, in this retrospective cohort study. Main outcome measures were Severe Maternal Morbidity score and the Neonatal Adverse Outcome Indicator (NAOI). RESULTS Among the 733 052 pregnancies included, 10 829 presented a severe maternal morbidity (1.48%) and 77 237 had a neonatal adverse outcome (10.4%). Factors associated with an unfavorable maternal or neonatal outcome were Obstetric Comorbidity Index, primiparity, and cesarean or instrumental delivery. Prematurity was associated with less severe maternal morbidity but more neonatal adverse outcomes. Time of travel above 30 min was associated with a higher NAOI rate. CONCLUSIONS Results suggest the efficiency of regionalization of perinatal care in France, although a difference in both outcomes persists according to unit volume, suggesting the need for a further step in concentrating perinatal care. Perinatal care organization should focus on mapping the territory with high-level, high-volume maternity throughout the territory; this suggests closing down high-volume units and improving low-volume ones to maintain coherent mapping.

[1]  O. Morel,et al.  Démographie médicale : les maternités sont en danger. Comment préparer l’avenir? , 2022, Gynécologie Obstétrique Fertilité & Sénologie .

[2]  J. Zeitlin,et al.  Measuring severe neonatal morbidity using hospital discharge data in France. , 2021, Paediatric and perinatal epidemiology.

[3]  A. Metcalfe,et al.  Impact of the ICD-9-CM to ICD-10-CM transition on the incidence of severe maternal morbidity amongst delivery hospitalizations in the United States. , 2021, American journal of obstetrics and gynecology.

[4]  O. Stephansson,et al.  Association between travel time to delivery unit and unplanned out‐of‐hospital birth, infant morbidity and mortality: A population‐based cohort study , 2021, Acta obstetricia et gynecologica Scandinavica.

[5]  W. Dotse-Gborgbortsi,et al.  The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria , 2021, PloS one.

[6]  F. Alderdice,et al.  Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review , 2020, BMJ Open.

[7]  D. Lyell,et al.  An Expanded Obstetric Comorbidity Scoring System for Predicting Severe Maternal Morbidity. , 2020, Obstetrics and gynecology.

[8]  J. Profit,et al.  The changing landscape of perinatal regionalization. , 2020, Seminars in perinatology.

[9]  J. Chabernaud,et al.  Out-of-maternity deliveries in France: A nationwide population-based study , 2020, PloS one.

[10]  J. Gagne,et al.  Validation of a comorbidity index for use in obstetric patients: A nationwide cohort study , 2019, Acta obstetricia et gynecologica Scandinavica.

[11]  F. Puech.  Le temps, les temporalités et l’état de l’organisation des soins en périnatalité en France , 2019, Périnatalité.

[12]  F. Shebl,et al.  Area-level deprivation and preterm birth: results from a national, commercially-insured population , 2019, BMC Public Health.

[13]  Hannah E Knight,et al.  Establishing a composite neonatal adverse outcome indicator using English hospital administrative data , 2018, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[14]  H. Dahlen,et al.  Born before arrival in NSW, Australia (2000–2011): a linked population data study of incidence, location, associated factors and maternal and neonatal outcomes , 2018, BMJ Open.

[15]  L. Lehtonen,et al.  Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks , 2017, Pediatrics.

[16]  O. Norheim,et al.  Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population‐based study , 2017, American journal of obstetrics and gynecology.

[17]  T. Farragher,et al.  Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review , 2016, BMJ Open.

[18]  Yvonne W. Cheng,et al.  Planned Out-of-Hospital Birth and Birth Outcomes. , 2015, New England Journal of Medicine.

[19]  M. Gissler,et al.  Out‐of‐hospital deliveries have risen involving greater neonatal morbidity , 2015, Acta paediatrica.

[20]  J. V. van Roosmalen,et al.  Ambulance Transfer in Case of Postpartum Hemorrhage after Birth in Primary Midwifery Care in The Netherlands: A Prospective Cohort Study. , 2015, Birth.

[21]  M. Lapeyre-Mestre,et al.  French health insurance databases: What interest for medical research? , 2015, La Revue de medecine interne.

[22]  F. Dunstan,et al.  Perinatal outcomes and travel time from home to hospital: Welsh data from 1995 to 2009 , 2014, Acta paediatrica.

[23]  R. Yousefi-Nooraie,et al.  The effectiveness of regionalization of perinatal care services--a systematic review. , 2014, Public health.

[24]  L. Monkerud,et al.  Regionalization and local hospital closure in Norwegian maternity care--the effect on neonatal and infant mortality. , 2014, Health services research.

[25]  H. Horiguchi,et al.  Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy , 2014, The British journal of surgery.

[26]  R. Mori,et al.  Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health , 2014, BJOG : an international journal of obstetrics and gynaecology.

[27]  M. Gissler,et al.  Determining obstetric patient safety indicators: the differences in neonatal outcome measures between different‐sized delivery units , 2014, BJOG : an international journal of obstetrics and gynaecology.

[28]  C. Deneux-Tharaux,et al.  Ten Years of Confidential Inquiries Into Maternal Deaths in France, 1998–2007 , 2013, Obstetrics and gynecology.

[29]  S. Cousens,et al.  Newborn survival: a multi-country analysis of a decade of change. , 2012, Health policy and planning.

[30]  Ann-Beth Moller,et al.  National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications , 2012, The Lancet.

[31]  C. Roberts,et al.  Quality of Data in Perinatal Population Health Databases: A Systematic Review , 2012, Medical care.

[32]  M. Gissler,et al.  Should births be centralised in higher level hospitals? Experiences from regionalised health care in Finland , 2011, BJOG : an international journal of obstetrics and gynaecology.

[33]  Hiroyuki Kawaguchi,et al.  Neonatal mortality rate reduction by improving geographic accessibility to perinatal care centers in Japan. , 2011, Journal of medical and dental sciences.

[34]  Özge Tunçalp,et al.  National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis , 2011, The Lancet.

[35]  A. Abu-Hanna,et al.  Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands , 2011, BJOG : an international journal of obstetrics and gynaecology.

[36]  R. Rochat,et al.  Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. , 2010, JAMA.

[37]  Gary L Darmstadt,et al.  and methods overview 3 . 2 million stillbirths : epidemiology and overview of the evidence review , 2009 .

[38]  D. Chang,et al.  A national analysis of the relationship between hospital volume, academic center status, and surgical outcomes for abdominal hysterectomy done for leiomyoma. , 2009, Journal of the American College of Surgeons.

[39]  Béatrice Blondel,et al.  Impact of maternity unit closures on access to obstetrical care: the French experience between 1998 and 2003. , 2008, Social science & medicine.

[40]  M. Morelle,et al.  Effects of residential distance to hospitals with neonatal surgery care on prenatal management and outcome of pregnancies with severe fetal malformations , 2007, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[41]  K. Joseph,et al.  The influence of hospital closures in Nova Scotia on perinatal outcomes. , 2004, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.

[42]  C. Ananth,et al.  The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. , 2002, American journal of obstetrics and gynecology.

[43]  R. Deyo,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. , 1992, Journal of clinical epidemiology.

[44]  O. Morel,et al.  Évaluation des critères de choix du futur lieu d’exercice chez les internes lorrains de gynécologie , 2018 .

[45]  C. Roberts,et al.  Incidence of Severe Adverse Neonatal Outcomes: Use of a Composite Indicator in a Population Cohort , 2011, Maternal and Child Health Journal.

[46]  C. Steiner,et al.  Comorbidity measures for use with administrative data. , 1998, Medical care.

[47]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[48]  G. Ryan.  Toward improving the outcome of pregnancy Recommendations for the regional development of perinatal health services. , 1975, Obstetrics and gynecology.