[Evaluation of a perinatal network using the first certificates of health]

To describe the methodology for continuous reporting of perinatal indicators in Maternité en Yvelines et Pays Associés (MYPA) network, and the main results for its evaluation. To discuss the implications for practice in a perinatal network.

CoNaissance 78 program is a collaboration between MYPA network, Conseil général des Yvelines, ARS Île-de-France and U953 Inserm unit. Continuous recording of data is produced using the first certificate of health (PCS) of infants born in the network maternities, an additional health certificate including data about severe maternal morbidity, perineal tears and episiotomies, and a stillbirth certificate including all cases of fetal deaths and medical termination of pregnancy from 22weeks of gestation. Description of the population and obstetric practices with comparison between the network maternities covers the period from 2008 to 2011.

The analysis includes 79,232 births. The used variables had a missing data rate below 5%. The mean maternal age at delivery was 30.9, women aged 35years or above accounting for 23.2% of deliveries (from 17.1 to 32.8% according to the maternity, P<0.001). Nullipara rate was 42.5% (from 36.6 to 50% according to the maternity, P<0.001) and multiple pregnancies rate was 1.8% (from 0.3 to 3.4% according to the maternity, P<0.001). Mode of onset of labor was spontaneous in 66.1% cases (from 55.5 to 72.9% according to the maternity, P<0.001), induced in 21.5% cases (from 16.9 to 30.8% according to the maternity, P<0.001) and a planned cesarean section was performed in 12.4% cases (from 8.4 to 19.6% according to the maternity, P<0.001). The global mean rate of cesarean sections was 24.3% (from 18.4 to 29.6% according to the maternity, P<0.001). The cesarean section rate was in a selected low risk group was 14.7% (from 11.4 to 20.2% [P<0.001] according to the maternity). The episiotomy rate was 26.1% (from 16.3 to 43.6% [P<0.001] according to the maternity). The rate of very preterm neonates born alive inside a tertiary center was 70.8%.

This program allowed to observe a large disparity in practices, and highlighted significant shortcomings in the organization of in utero transfers to the tertiary center for very preterm births.