Objective: To explore the differences in very preterm pregnancy outcome between two geographically defined populations in Europe with similar socio- economic and health care provision but different organisational arrangements for perinatal care.
Design:Prospective cohort study.
Setting: Nord Pas-de-Calais (NPC), France and Trent, UK.
Participants: All pregnancy outcomes 22+0 to 32+6 weeks gestational age for resident mothers.
Outcome measures: Mortality patterns (antepartum death, intrapartum death, labour ward death and neonatal unit death) of very preterm babies were compared by region. Multinomial logistic regression was used to model regional differences for a variety of pregnancy outcomes and to adjust for regional differences in the organisation of perinatal care.
Results: The delivery of very preterm infants was significantly higher in Trent compared to NPC: (1.9% cf 1.5% of all births). The stillbirth rate was significantly higher in NPC (23.0%, 95% ci 20.0 to 26.5 cf 14.4%, 95% ci 12.3 to 16.6) and survival to discharge was higher in Trent (74.6% 95%ci 71.9 to 77.1 cf 66.7% 95%ci 63.3 to 69.9). The probability of intra-partum and labour ward death in NPC was more than five times higher than Trent (RRR 5.3, 95% ci 2.2 to 13.1).
Conclusion: The high rate of very preterm deliveries and the larger proportion of these infants recorded as live born in Trent appear to be the cause of the excess neonatal mortality seen in the routine statistics. Information about very preterm babies (not usually included in routine statistics) is vital if inappropriate interpretation of international perinatal and infant data is to be avoided. This study highlights the importance of including deaths before transfer to neonatal care emphasising the need to include the outcome of all pregnancies in a population in any comparative analysis.
- International comparisons
- extreme prematurity
- perinatal and infant mortality
- preterm birth
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