Papiernik E, Keith L G
Maternité de Port-Royal, Hôpital Cochin Université René Descartes 123, Paris, France.
Eur J Obstet Gynecol Reprod Biol. 1995 Aug;61(2):99-103. doi: 10.1016/0301-2115(95)02107-i.
This paper reviews published data on the organization and evaluation of regionalized perinatal care programs in countries where they exist and describes those elements presently lacking in France. The advantage of maternal compared to neonatal transport is described vis-85-vis its effect on perinatal deaths as well as neonatal and developmental handicaps. Most studies describe a major advantage of maternal transfers, with less perinatal deaths (including stillbirths and neonatal deaths) and lower rates of severe developmental handicaps. In contrast, French publications show that widespread regionalization of perinatal care does not exist in spite of proposals advocating this concept made more than 20 years ago. Thus, many deliveries of less than 33 weeks gestation length or/and less than 1500 g birth weight take place in maternity sites without adequate neonatal care, despite ample evidence that such infants are at much greater risk of perinatal death or severe handicaps at 2 years of age after transfer than if they had been born in a perinatal center. For these reasons, professional organizations in France should choose to implement a policy of maternal transfers as a major effort in the near future.
本文回顾了已有围产期护理区域化项目的国家中关于此类项目组织与评估的已发表数据，并描述了法国目前所缺乏的那些要素。相较于新生儿转运，阐述了孕产妇转运在围产期死亡以及新生儿和发育障碍方面的优势。大多数研究表明孕产妇转运具有显著优势，围产期死亡（包括死产和新生儿死亡）更少，严重发育障碍发生率更低。相比之下，法国的出版物显示，尽管二十多年前就有人提议推行围产期护理区域化的概念，但目前这种广泛的区域化并不存在。因此，许多孕周小于33周或出生体重小于1500克的分娩在没有足够新生儿护理的产科进行，尽管有充分证据表明，与在围产期中心出生相比，这些婴儿转运后在围产期死亡或两岁时出现严重障碍的风险要高得多。基于这些原因，法国的专业组织应选择在不久的将来实施一项以孕产妇转运为主要举措的政策。
