Effects of residential distance to hospitals with neonatal surgery care on prenatal management and outcome of pregnancies with severe fetal malformations.
OBJECTIVE
To examine the effect of maternal origin and distance between maternal residence and the nearest maternity ward with a neonatal surgical center in the same hospital, on prenatal diagnosis, elective termination of pregnancy, delivery in an adequate place and neonatal mortality for pregnancies with severe malformations requiring neonatal surgery, and to examine the effect of the place of delivery on neonatal mortality.


METHODS
This was a retrospective study, through the France Central-East malformation registry, of 706 fetuses with omphalocele (n = 123), gastroschisis (n = 99), diaphragmatic hernia (n = 222), or spina bifida (n = 262), but without chromosomal anomalies. Maternal origin was classified as Western European and non-Western European. Adequate place for delivery was defined as birth in a Level-III maternity ward with a neonatal surgical center in the same hospital.


RESULTS
The prenatal diagnosis rate was 67.7% in 1990-1995 and 80.2% in 1996-2001 (odds ratio (OR), 2.07 (95% CI, 1.24-3.45)). On multivariate analysis, the rate was significantly lower for women living 11-50 km (adjusted OR, 0.49 (95% CI, 0.25-0.94)), or > 50 km (adjusted OR, 0.39 (0.20-0.74)) from the closest adequate place of delivery, compared with those living < 11 km from it, but there was no difference for maternal origin. Non-Western European women had fewer elective terminations of pregnancy (adjusted OR, 0.34 (95% CI, 0.14-0.81)) and fewer deliveries in an adequate place (adjusted OR, 0.40 (95% CI, 0.18-0.89)). Neonatal mortality was lower in the case of delivery in an adequate place (adjusted OR, 0.22 (95% CI, 0.07-0.72)) and was not associated with maternal origin and distance from nearest maternity ward with a neonatal surgical center.


CONCLUSIONS
Rate of prenatal diagnosis decreases with increasing distance between parental residence and referral center. Non-Western European women are diagnosed prenatally as often as are Western Europeans, but terminate their pregnancy less often, perhaps for cultural reasons. Non-Western European women with malformed fetuses deliver in adequate centers less often, probably because of the way the perinatal care system is run.
Pasquier
J-C
JC
Department of Obstetrics and Gynecology, Université de Sherbrooke, Quebec, Canada. jean-charles.pasquier@usherbrooke.ca
Morelle
M
M
Bagouet
S
S
Moret
S
S
Luo
Z-C
ZC
Rabilloud
M
M
Gaucherand
P
P
Robert-Gnansia
E
E
D000025:Abortion, Eugenic / Q000706:statistics & numerical data; D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000601:surgery*; D005006:Ethnicity; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D015999:Multivariate Analysis; D016017:Odds Ratio; D010500:Perinatology; D011247:Pregnancy; D012041:Regional Medical Programs / Q000458:organization & administration; D012189:Retrospective Studies; D013223:Statistics as Topic; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data