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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, M.J.M.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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Access to level III perinatal care for pregnancies of very short duration (<32 weeks)

Anteo Di Napoli1 / Domenico Di Lallo1 / Francesco Franco1 / Maria Eleonora Scapillati2 / Carlo Zocchetti3 / Rocco Agostino4 / Marcello Orzalesi5

1Agency for Public Health, Lazio Region, Rome, Italy

2San Pietro Fatebenefratelli Hospital, Rome, Italy

3Regional Health Authority, Lombardia Region, Milan, Italy

4San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy

5Bambino Gesù Children Hospital, Rome, Italy

Corresponding author: Dr. Anteo Di Napoli, MD Agency for Public Health of Lazio Region Via di Santa Costanza 53 – 00198 Rome Italy Tel.: +39-0683060452 Fax: +39-0683060463

Citation Information: Journal of Perinatal Medicine. Volume 37, Issue 3, Pages 236–243, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2009.049, February 2009

Publication History

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Aims: To evaluate to which extent pregnancies of very short duration (<32 weeks' gestation) are concentrated in level III centers.

Methods: Area-based study in the 57 maternity units of the Lazio Region (Italy), years 2003–2004, including: 1012 live births (gestational age 22–31 weeks), 261 fetal losses (22–31 weeks) and 209 induced abortions (22–25 weeks). Variables associated with access to a level III unit were evaluated through multivariable logistic regression models.

Results: 83.7% of all pregnancies <32 weeks (88.8% of live births, 71.6% of fetal losses and 75.1% of induced abortions) were admitted to a level III perinatal center; 23.4% of live newborns, delivered in a level III hospital, were subsequently transferred to a same level facility. The probability that a fetal loss was not treated in a level III perinatal unit was higher for women without pregnancy complication, with lower education level, and living outside the metropolitan area.

Conclusions: Regionalization of perinatal care in Lazio is not satisfactory. Concentration of high-risk deliveries in level III centers is good, but in utero transfer is insufficient. This study can help to define the effectiveness of different organizational systems on access to locally available perinatal facilities and to optimize general organizational patterns of perinatal care.

Keywords: Access to perinatal care; appropriateness; perinatal level unit; perinatal transfer; very preterm pregnancies

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