[Assessment of three-level selective perinatal care based on the analysis of early perinatal death rates and cesarean sections in Poland in 2008].
OBJECTIVE
The aim of the following work was to assess three-level selective perinatal care in Polish voivodeships in 2008 on the basis of the following parameters: birth rates as well as perinatal death rates, divided into three classes of neonatal weights, in hospitals on each of the three levels. The goal of selective perinatal care is, among other things, to diagnose threats to the mother and/or fetus and direct women with high-risk pregnancies to higher level obstetrics and neonatology clinics and units. The structure of a regional three-level perinatal care, as well as the rules and procedures governing the process of redirecting patients to different levels of perinatal care have been defined in great detail.


METHODS
Perinatal death rates analysis has been carried out on the basis of data received from Voivodeship Public Health Centers in sixteen voivodeships in Poland in 2008. The main document constituted MZ-29 form section X, modified by the authors and subdivided into levels of perinatal care. All data contained in the form have been verified: the numbers concerning birth and death rates as well as perinatal deaths and birth weight subgroups from given voivodeship hospitals. Statistic analysis was limited to the presentation of result tables and graphs within voivodeships.


RESULTS
Birth rates and perinatal death rates revealed that in the course of ten years the level of perinatal care, introduced gradually in Poland between the years 1997-1999, resulted in its improvement. Perinatal death rates decreased in the course of ten years from 9.5% in 1999 to 6.45% in 2008, i.e. by 0.3% annually. On the first level, the rate of neonates with very low birth weight, 500-999g, decreased by 5.5% and was 21.1% in 2008 and 36.6% in 1999, whereas on the third level, the birth rate in the same group (500-999g) increased by 12.7% and was 47.7% in 2008 and 35.5% in 1999. There is a growing and alarming tendency to perform cesarean sections. The increase amounted up to 1.2% annually (18.2% in 19999 and 30.5% in 2008), with vast differences among hospitals and voivodeships. In 2008 there were 28.4% of cesarean sections in level one-hospitals, 29.3% in level two-hospitals and 40.6% in level three-hospitals.


CONCLUSIONS
The results of an overall decrease in perinatal deaths rate and an increase in birth rates in the group of neonates with very low birth weight on the third level are not satisfactory. Reintroduction of the program and strategy from the years 1995 and 1997 will enable us to improve the situation. Particularly this should be the case on the basic level perinatal care. In the context of three-level selective strategy the reintroduction of periodical analysis of perinatal care results is essential.
Troszyński
Michał
M
Zakad Zdrowia Prokreacyjnego, Instytut Matki i Dziecka, Warszawa, ul. Kasprzaka 17A. michal.troszynski@imid.med.pl
Niemiec
Tomasz
T
Wilczyńska
Anna
A
D000328:Adult; D002585:Cesarean Section / Q000401:mortality*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008499:Medical Records / Q000706:statistics & numerical data; D054238:Perinatal Mortality; D011044:Poland / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult