Lecoeur Christelle, Thibon Pascal, Prime Ludovic, Mercier Pierre-Yves, Balouet Pierre, Durin Luc, Deon Grégory, Lefevre Paul, Le Coutour Xavier, Guillois Bernard, Dreyfus Michel
CHU de Caen, Réseau de périnatalité, Caen F-14000, France; CHU de Caen, Service de gynécologie-Obstétrique, Caen F-14000, France.
CHU de Caen, Réseau de périnatalité, Caen F-14000, France.
Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:22-6. doi: 10.1016/j.ejogrb.2014.05.009. Epub 2014 May 21.
To evaluate the rate and circumstances of outborn deliveries within a French perinatal network, and to determine their avoidability.
Cohort study including preterm infants <33 weeks gestation and/or weighing <1500g born outside a level III maternity unit in Lower Normandy region, France, in 2008-2010. In 2008 and 2009, only neonates transferred to the Caen University Teaching Hospital (CHU) were included. In 2010, all outborn neonates in the region were included by means of a medical information system program. A panel of 7 experts was set up to determine the avoidability of each outborn case using a two-stage modified Delphi procedure. Inter-expert agreement was evaluated using the kappa index.
Sixty-four cases (71 neonates) were included. The outborn rate in 2010 was 16.1% (40/248, 95% CI (116-207%)). The most common reason for delivery was spontaneous onset of labour (57.8%). In 12 cases, the place of birth (level 2b maternity unit) was considered to be appropriate by the experts (term ≥32WG), but 8 cases involved infants of low birth weight (<1500g). For the 52 cases born in inappropriate sites, 9.6% were considered to be avoidable (kappa index=0.42 (p<10-3)).
Our outborn rate meets regionalisation targets. Our method of expert evaluation identified a small percentage of avoidable births in inappropriate sites. Regular reassessment of obstetric practices and good coordination between network actors are crucial to improve the management of pregnancies at risk of outborn delivery.
评估法国围产期网络中外地分娩的发生率及情况，并确定其可避免性。
队列研究，纳入2008 - 2010年在法国下诺曼底地区三级产科单位以外出生的孕周<33周和/或体重<1500g的早产儿。2008年和2009年，仅纳入转至卡昂大学教学医院（CHU）的新生儿。2010年，通过医疗信息系统程序纳入该地区所有外地出生的新生儿。成立了一个由7名专家组成的小组，采用两阶段改良德尔菲法确定每例外地分娩病例的可避免性。使用kappa指数评估专家间的一致性。
共纳入64例（71名新生儿）。2010年外地分娩率为16.1%（40/248，95%可信区间（116 - 207%））。最常见的分娩原因是自然临产（57.8%）。12例中，专家认为出生地点（2b级产科单位）合适（孕周≥32周），但8例涉及低出生体重儿（<1500g）。对于在不合适地点出生的52例，9.6%被认为是可避免的（kappa指数 = 0.42（p<10 - 3））。
我们的外地分娩率符合区域化目标。我们的专家评估方法确定了在不合适地点出生的可避免分娩的小比例。定期重新评估产科实践以及网络参与者之间的良好协调对于改善有外地分娩风险的妊娠管理至关重要。
