Access to level III perinatal care for pregnancies of very short duration (<32 weeks).
OBJECTIVE
To evaluate to which extent pregnancies of very short duration (<32 weeks' gestation) are concentrated in level III centers.


METHODS
Area-based study in the 57 maternity units of the Lazio Region (Italy), years 2003-2004, including: 1012 live births (gestational age 22-31 weeks), 261 fetal losses (22-31 weeks) and 209 induced abortions (22-25 weeks). Variables associated with access to a level III unit were evaluated through multivariable logistic regression models.


RESULTS
83.7% of all pregnancies <32 weeks (88.8% of live births, 71.6% of fetal losses and 75.1% of induced abortions) were admitted to a level III perinatal center; 23.4% of live newborns, delivered in a level III hospital, were subsequently transferred to a same level facility. The probability that a fetal loss was not treated in a level III perinatal unit was higher for women without pregnancy complication, with lower education level, and living outside the metropolitan area.


CONCLUSIONS
Regionalization of perinatal care in Lazio is not satisfactory. Concentration of high-risk deliveries in level III centers is good, but in utero transfer is insufficient. This study can help to define the effectiveness of different organizational systems on access to locally available perinatal facilities and to optimize general organizational patterns of perinatal care.
Di Napoli
Anteo
A
Agency for Public Health, Lazio Region, Rome, Italy. dinapoli@asplazio.it
Di Lallo
Domenico
D
Franco
Francesco
F
Scapillati
Maria Eleonora
ME
Zocchetti
Carlo
C
Agostino
Rocco
R
Orzalesi
Marcello
M
D000032:Abortion, Therapeutic / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005865:Gestational Age; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D018743:Perinatal Care; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*