title: Improvement of first-trimester ultrasound screening in socially deprived settings through a community-based perinatal network.
abstract: BACKGROUND
  The North Paris community-based Perinatal Network was set up in 2003 to improve the quality of prenatal care in an area surrounding the Bichat Claude Bernard University Hospital characterized by high social deprivation. The aim of this study is to assess the impact of the network on early perinatal care.
  
  
  METHODS
  A retrospective observational study on medical records was conducted over four periods: one year before the setting up of the network (2002), the year the network became operational (2003), and one year (2004) and five years (2008) after implementation. Endpoints were the proportion of women delivered in the institution who underwent first-trimester ultrasound screening and the proportion of nuchal translucency measurements deemed acceptable (image quality score from 4 to 9 according to the Herman scoring system).
  
  
  RESULTS
  Between 2002 and 2004, substantial improvements were noted in access to first-trimester ultrasound screening (55.8% in 2002, 65.9% in 2003, 71.9% in 2004, P<0.05) and in the quality of nuchal translucency measurement (acceptable measurement over this period, 51.1%, 67.8% and 77.8%, respectively, P<0.001). Five years after network set-up, indicators remained unchanged from those of 2004. The rate of first ultrasound screening performed was 72.1% and the rate of acceptable measurement 71.1%, both non-statistically different from 2004 rates.
  
  
  CONCLUSIONS
  This perinatal network seems to be associated with an improvement in early prenatal care. However, the rate of first ultrasound performed remained unsatisfactory and to further improve these indicators, upstream social interventions are needed.
authors: Department of Obstetrics and Gynaecology, Groupe Bichat Claude Bernard, APHP, Paris, France. elie.azria@bch.aphp.fr
authors: Elie
authors: E
authors: Azria
authors: Lydia
authors: L
authors: Guittet
authors: Magalie
authors: M
authors: Delahaye
authors: Martin
authors: M
authors: Koskas
authors: Iptisem
authors: I
authors: Naoura
authors: Dominique
authors: D
authors: Luton
authors: Dominique Mahieu
authors: DM
authors: Caputo
mesh_terms: D003467:Cultural Deprivation; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008430:Maternal-Child Health Centers; D008499:Medical Records; D048208:Nuchal Translucency Measurement / Q000706:statistics & numerical data; D010297:Paris; D010342:Patient Acceptance of Health Care; D018743:Perinatal Care / Q000379:methods*; D011204:Poverty Areas; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods*; D011610:Psychosocial Deprivation; D058996:Quality Improvement; D012189:Retrospective Studies; D012944:Social Support; D012959:Socioeconomic Factors; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data