Clerc J, Doret M, Decullier E, Claris O, Picaud J-C, Dupuis O
Service de gynécologie-obstétrique, centre hospitalier Lyon Sud, 165 chemin du Grand-Revoyet, Pierre-Bénite cedex, France.
Gynecol Obstet Fertil. 2011 Jul-Aug;39(7-8):412-7. doi: 10.1016/j.gyobfe.2011.02.020. Epub 2011 Jul 13.
The main objective of this study was to calculate the percentage of preterm births before 28 weeks gestational age (weeks GA) outside level-3 maternity wards and determine how many could have been prevented.
This was an observational, multicenter, retrospective cohort study, which included all the deliveries that occurred between 24 and 27 weeks GA + 6 days in the Greater Lyon perinatal network (France) occurring between first of March 2008 and first of March 2009. In utero transfers (IUTs) and newborn transfers (NBTs) which were carried out outside the network, medical abortions, and foetal deaths in utero were excluded. The duration between patient's arrival in the level 1 and 2 maternity and birth was compared at the 97(th) percentile of the mother's transfer time in level-3 maternity. Births that occurred outside of level-3 maternity wards were considered avoidable each time the first duration was more than the second.
During the study period, 113 infants were born alive between 24 and 27 weeks GA+6 days in the network. They were all included in the study. Ninety were born in a level-3 maternity ward and 23 were born in level-1 and 2 maternity wards (20%). There were 35 requests for IUT and 28 were carried out (80%). In 65% of non-level 3 births, no IUT was requested. In 17% of cases, an IUT request could have prevented births in level 1/2 maternity wards. If twin pregnancies had been transferred to a level-3 maternity ward, 26% of non-level 3 births would have been avoided. If all high-risk pregnancies had been transferred to a level-3 maternity ward, 40% of non-level 3 births would have been avoided.
Any time a pregnant woman is hospitalized in a type 1/2 maternity ward before 28 weeks GA, doctors should consider an in utero transfer to a level-3 maternity ward. It may be possible to lower the birth-rate of non-level 3 births by a targeted increase in in utero transfers and by transferring high-risk pregnancies to a level-3 maternity ward.
本研究的主要目的是计算孕周在28周之前（孕龄，GA）三级产科病房以外的早产百分比，并确定其中有多少早产是可以避免的。
这是一项观察性、多中心、回顾性队列研究，纳入了2008年3月1日至2009年3月1日在法国大里昂围产期网络中发生的所有孕龄在24至27周+6天的分娩。排除在网络外进行的宫内转运（IUT）和新生儿转运（NBT）、人工流产以及宫内死胎。将患者到达一级和二级产科病房至分娩的时间与三级产科病房中母亲转运时间的第97百分位数进行比较。每当第一个时间超过第二个时间时，在三级产科病房以外发生的分娩就被视为可避免的。
在研究期间，网络中有113名婴儿在孕龄24至27周+6天之间存活出生。他们都被纳入了研究。90名在三级产科病房出生，23名在一级和二级产科病房出生（20%）。有35次宫内转运请求，其中28次得到执行（80%）。在65%的非三级分娩中，未提出宫内转运请求。在17%的病例中，宫内转运请求本可避免在一级/二级产科病房分娩。如果双胎妊娠被转运至三级产科病房，26%的非三级分娩本可避免。如果所有高危妊娠都被转运至三级产科病房，40%的非三级分娩本可避免。
每当一名孕妇在孕龄28周之前在一级/二级产科病房住院时，医生都应考虑将其宫内转运至三级产科病房。通过有针对性地增加宫内转运以及将高危妊娠转运至三级产科病房，有可能降低非三级分娩的出生率。
