Zur Regionalisierung der perinatalen Versorgung - Wie häufig sind Fehlplatzierungen von Risikogebärenden?

BACKGROUND: The concentration of high-risk deliveries in specialized perinatal care centres contributes to the reduction of infant mortality and morbidity. This study investigates the frequency of high-risk deliveries in hospitals with inadequate level of perinatal care. METHODS: From the files of a German statutory health insurance we draw a random sample of 3.967 women who gave birth april to june 2002. The women received a questionnaire and were asked to send in their "maternity logbook", a document that every pregnant woman receives and where prenatal visits and births are documented by the obstetricians in standardized form. From the 1,593 responders (response rate 40.2 %) we selected 559 high-risk cases. 83 of these (14.8 %) delivered at a specialized perinatal care centre. The remaining 476 deliveries were subjected to an individual analysis of their data. Based on published guidelines for antenatal transport and on data about the perinatal care facilities of German hospitals the adequacy of the delivery hospital was rated for each case. RESULTS: 2.4 % of the whole sample (38/1,503) were classified as "inadequate hospital of delivery". 17 of these 38 cases were considered as potentially avoidable because significant antepartal risk factors were documented. 5 (25 %) of the 20 highest risk cases (twins < 36 weeks of gestational age, singletons < 32 weeks, infants < 1.500 g) were classified as avoidable referrals to inadequate hospitals. CONCLUSIONS: Regionalization of perinatal care must be enhanced by adequate appreciation of antenatal risk factors and counselling of pregnant women on the choice of place of delivery.