The case for small rural hospital obstetrics.
Small obstetrical units can offer a very competitive quality of service as compared to large centres. They achieved this quality of service by transferring all high-risk deliveries to specialized regional centres with neonatal intensive care facilities (perinatal regionalization). The significant decrease in perinatal mortality over the past 20 years is a result of the superior care of low birth-weight infants, available in these large centres. It is not surprising that some people might project this superior performance to all weight categories. A review of the literature, however, shows that overall, small (level I) hospitals are as safe as larger centres. The authors discuss the means by which small, and often isolated, centres do as well as better equipped and more extensive centres with larger staffs.
W
W
Hogg
J
J
Lemelin
J Fam Pract. 1978 Jun;6(6):1209-16
660124
Obstet Gynecol. 1979 Feb;53(2):187-9
418973
J Fam Pract. 1976 Aug;3(4):397-401
1053498
Pediatrics. 1980 Oct;66(4):540-6
7432839
Lancet. 1980 Dec 13;2(8207):1287-9
6108458
Br Med J (Clin Res Ed). 1984 May 12;288(6428):1438-40
6426591
Am J Obstet Gynecol. 1983 Jun 15;146(4):450-5
6859164
Am J Obstet Gynecol. 1983 Jan 15;145(2):170-6
6849351
Can Fam Physician. 1984 Feb;30:326-32
21279011
Br Med J (Clin Res Ed). 1982 Feb 13;284(6314):488-90
6800508
Can Fam Physician. 1984 Feb;30:343-7
21279013
Clin Perinatol. 1980 Mar;7(1):197-203
7398180
Clin Perinatol. 1980 Mar;7(1):205-21
7398181
J R Coll Gen Pract. 1981 Jun;31(227):357-67
7299730
Am J Obstet Gynecol. 1983 Mar 1;145(5):545-52
6829629
Obstet Gynecol. 1979 Sep;54(3):330-2
471374
Hosp Health Serv Adm. 1981 Winter;26(1):70-88
10251437
Minn Med. 1981 Oct;64(10):637-40
6801450
Pediatrics. 1982 May;69(5):613-20
7079020
Obstet Gynecol. 1982 Apr;59(4):452-6
7078897
Obstet Gynecol. 1983 Sep;62(3):294-6
6877686
J R Coll Gen Pract. 1977 Jul;27(180):406-13
894639
Public Health Rep. 1982 Mar-Apr;97(2):134-9
7063594
Br J Obstet Gynaecol. 1983 Feb;90(2):123-8
6824612
J Fam Pract. 1980 Oct;11(4):601-6
7420036
J Pediatr. 1984 Jun;104(6):921-7
6726528
Obstet Gynecol. 1977 Sep;50(3):280-4
896095
Am J Obstet Gynecol. 1981 Dec 15;141(8):1045-52
7315916
Br J Obstet Gynaecol. 1983 Feb;90(2):118-22
6824611
Can Med Assoc J. 1984 Mar 1;130(5):571-6
6697267
Am J Public Health. 1985 Feb;75(2):156-60
3966621
Lancet. 1985 Aug 24;2(8452):429-32
2863454
Am J Obstet Gynecol. 1982 Jul 1;143(5):533-7
7091224
Med Care. 1981 Apr;19(4):393-409
7230933
Can Med Assoc J. 1984 May 15;130(10):1311-5
6722695