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Improvement of first-trimester ultrasound screening in socially deprived settings through a community-based perinatal
Elie Azria1, Lydia Guittet, Magalie Delahaye
1Department of Obstetrics and Gynaecology, Groupe Bichat Claude Bernard, APHP, Paris, France. elie.azria@bch.aphp.fr
Insights
The North Paris Perinatal Network improved early prenatal care, increasing first-trimester ultrasounds and nuchal translucency measurement quality. However, further social interventions are needed to improve screening rates.
Area of Science:
- Perinatal health
- Public health initiatives
- Prenatal care quality improvement
Background:
- Established in 2003, the North Paris community-based Perinatal Network aimed to enhance prenatal care in a socially deprived area.
- The network serves the region around Bichat Claude Bernard University Hospital.
Purpose of the Study:
- To evaluate the impact of the North Paris Perinatal Network on early perinatal care.
- Assessing the network's effect on first-trimester ultrasound screening and nuchal translucency measurement quality.
Main Methods:
- Retrospective observational study using medical records from 2002, 2003, 2004, and 2008.
- Key endpoints included the proportion of women receiving first-trimester ultrasound screening and the quality of nuchal translucency measurements.
Main Results:
- Significant improvements observed in first-trimester ultrasound screening rates (55.8% to 71.9%) and nuchal translucency measurement quality (51.1% to 77.8%) between 2002 and 2004.
- These improvements were sustained five years post-implementation, with rates at 72.1% and 71.1% respectively in 2008.
Conclusions:
- The perinatal network is associated with enhanced early prenatal care quality.
- Despite improvements, first-trimester ultrasound rates remain suboptimal, indicating a need for upstream social interventions.
Introduction:
The North Paris community-based Perinatal Network was set up in 2003 to improve the quality of prenatal care in an area surrounding the Bichat Claude Bernard University Hospital characterized by high social deprivation. The aim of this study is to assess the impact of the network on early perinatal care.
Materials And Methods:
A retrospective observational study on medical records was conducted over four periods: one year before the setting up of the network (2002), the year the network became operational (2003), and one year (2004) and five years (2008) after implementation. Endpoints were the proportion of women delivered in the institution who underwent first-trimester ultrasound screening and the proportion of nuchal translucency measurements deemed acceptable (image quality score from 4 to 9 according to the Herman scoring system).
Results:
Between 2002 and 2004, substantial improvements were noted in access to first-trimester ultrasound screening (55.8% in 2002, 65.9% in 2003, 71.9% in 2004, P<0.05) and in the quality of nuchal translucency measurement (acceptable measurement over this period, 51.1%, 67.8% and 77.8%, respectively, P<0.001). Five years after network set-up, indicators remained unchanged from those of 2004. The rate of first ultrasound screening performed was 72.1% and the rate of acceptable measurement 71.1%, both non-statistically different from 2004 rates.
Conclusion:
This perinatal network seems to be associated with an improvement in early prenatal care. However, the rate of first ultrasound performed remained unsatisfactory and to further improve these indicators, upstream social interventions are needed.
