Influence of perinatal care regionalisation on the referral patterns of intermediate- and high-risk pregnancies

Objective(s): To use the delivery site according to the birth weight as a marker of changes in the referral practices after regionalisation of perinatal care. Study design: Analysis of the distribution of low birth weight infants according to the level of care in Rhone-Alpes from 1998 to 2000 and analysis of the birth rate heterogeneity according to the delivery site characteristics. Results: The distribution of infants <= 1500 g remained constant at all levels (60% at level 3). That of infants 1500-2000 g born at level 3 dropped in 2000 but raised at levels 1 and 2. For both weight categories, the lower birth rates corresponded to the private, the lower-flow, and the more distant from neonatal intensive care units facilities. For infants <= 1500 g, the level 3 birth rate was four times the level 2 (P = 0.0006) and five times the level 1 (P < 0.0001) rates. For infants 1500-2000 g, level 3 birth rate was twice the level 2 (P = 0.0096) and 3.6 times the level 1 (P < 0.0001) rates. Birth rates were always significantly higher in university than in private facilities. Conclusion(s): Supervising level 3 is insufficient to show the effect of regionalisation. A more accurate analysis of intermediate-risk referral determinants is needed to reach a more demand/supply adequacy. (c) 2005 Elsevier Ireland Ltd. All rights reserved.