Frequency, causes and avoidability of outborn births in a French regional perinatal network

To evaluate the rate and circumstances of outborn deliveries within a French perinatal network, and to determine their avoidability.

Cohort study including preterm infants <33 weeks gestation and/or weighing <1500g born outside a level III maternity unit in Lower Normandy region, France, in 2008-2010. In 2008 and 2009, only neonates transferred to the Caen University Teaching Hospital (CHU) were included. In 2010, all outborn neonates in the region were included by means of a medical information system program. A panel of 7 experts was set up to determine the avoidability of each outborn case using a two-stage modified Delphi procedure. Inter-expert agreement was evaluated using the kappa index.

Sixty-four cases (71 neonates) were included. The outborn rate in 2010 was 16.1% (40/248, 95% CI (116-207%)). The most common reason for delivery was spontaneous onset of labour (57.8%). In 12 cases, the place of birth (level 2b maternity unit) was considered to be appropriate by the experts (term ≥32WG), but 8 cases involved infants of low birth weight (<1500g). For the 52 cases born in inappropriate sites, 9.6% were considered to be avoidable (kappa index=0.42 (p<10-3)).

Our outborn rate meets regionalisation targets. Our method of expert evaluation identified a small percentage of avoidable births in inappropriate sites. Regular reassessment of obstetric practices and good coordination between network actors are crucial to improve the management of pregnancies at risk of outborn delivery.