title: [Regionalised perinatal care in cases of cervical incompetence and imminent premature birth].
abstract: BACKGROUND
  Premature birth due to cervical incompetence is a major obstacle of perinatal medicine. While measures of prevention have been investigated, the mother should be transferred to a perinatal centre when delivery < 34 + 0 weeks is imminent. Delivery in the state of Hessein the large majority of case is performed by medically indicated CS: We evaluated the potential prolongation of gestation in relation to the level of the institute.
  
  
  METHODS
  In order to evaluate the influence of the level of the obstetrical institute on the prolongation of pregnancy we used the data set of the Hesse perinatal survey (HEPE) of the years 1990 − 2009 (n = 449 933). A multivariate analysis excluding the confounders prematurity, IUGR,and maternal disease was performed to evaluate the relation of prolongation of gestation to the level of care.
  
  
  RESULTS
  Admissions with imminent premature birth due to cervical incompetence were identified in 6 892 cases. Overall prolongation until birth was 9.6 days. When the cervical incompetence was < 3 cm the difference between hospitals was not significant (12.7 vs. 13.1 d) days. With the cervix ≥ 3 cm the period after admission was merly 0.6 day in level I hospitals − thus significantly lower than in perinatal centres (6.5 days).
  
  
  CONCLUSIONS
  In order to achieve optimal conditions at birth for very premature newborns the organisation of perinatal care should aim at intrauterine transfer to a specialised perinatal unit.A precondition is a health system with an adequate structure of perinatal centres within 30 k min the case of obstetrical emergencies
authors.affiliation: Klinik für Geburtshilfe und Perinatalmedizin, Universitätsklinikum Marburg, Germany. schmidts@med.uni-marburg.de
authors.forename: S
authors.initials: S
authors.lastname: Schmidt
authors.forename: B
authors.initials: B
authors.lastname: Misselwitz
mesh_terms: D016550:Birthing Centers / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D005865:Gestational Age; D006801:Humans; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007752:Obstetric Labor, Premature / Q000453:epidemiology* / Q000517:prevention & control*; D010343:Patient Admission / Q000706:statistics & numerical data; D018743:Perinatal Care; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000453:epidemiology* / Q000517:prevention & control*; D012041:Regional Medical Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D015996:Survival Rate; D002581:Uterine Cervical Incompetence / Q000453:epidemiology* / Q000628:therapy*