[Regionalised perinatal care in cases of cervical incompetence and imminent premature birth].

INTRODUCTION

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).

CONCLUSION

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