Out-of-hospital births and the supply of maternity units in France.

International audienceMaternity unit closures in France have increased distances that women travel to deliver in hospital. We studied how the supply of maternity units influences the rate of out-of-hospital births using birth certificate data. In 2005-6, 4.3 per 1000 births were out-of-hospital. Rates were more than double for women living 30km or more from their nearest unit and were even higher for women of high parity. These associations persisted in multilevel analyses adjusting for other maternal characteristics. Long distances to maternity units should be a concern to health planners because of the maternal and infant health risks

Clarity and consistency in stillbirth reporting in Europe: why is it so hard to get this right?

Background Stillbirth is a major public health problem, but measurement remains a challenge even in high-income countries. We compared routine stillbirth statistics in Europe reported by Eurostat with data from the Euro-Peristat research network. Methods We used data on stillbirths in 2015 from both sources for 31 European countries. Stillbirth rates per 1000 total births were analyzed by gestational age (GA) and birthweight groups. Information on termination of pregnancy at ≥22 weeks’ GA was analyzed separately. Results Routinely collected stillbirth rates were higher than those reported by the research network. For stillbirths with a birthweight ≥500 g, the difference between the mean rates of the countries for Eurostat and Euro-Peristat data was 22% [4.4/1000, versus 3.5/1000, mean difference 0.9 with 95% confidence interval (CI) 0.8–1.0]. When using a birthweight threshold of 1000 g, this difference was smaller, 12% (2.9/1000, versus 2.5/1000, mean difference 0.4 with 95% CI 0.3–0.5), but substantial differences remained for individual countries. In Euro-Peristat, missing data on birthweight ranged from 0% to 29% (average 5.0%) and were higher than missing data for GA (0–23%, average 1.8%). Conclusions Routine stillbirth data for European countries in international databases are not comparable and should not be used for benchmarking or surveillance without careful verification with other sources. Recommendations for improvement include using a cut-off based on GA, excluding late terminations of pregnancy and linking multiple sources to improve the quality of national databases.publishedVersio

Variations in Multiple Birth Rates and Impact on Perinatal Outcomes in Europe

Objective Infants from multiple pregnancies have higher rates of preterm birth, stillbirth and neonatal death and differences in multiple birth rates (MBR) exist between countries. We aimed to describe differences in MBR in Europe and to investigate the impact of these differences on adverse perinatal outcomes at a population level. Methods We used national aggregate birth data on multiple pregnancies, maternal age, gestational age (GA), stillbirth and neonatal death collected in the Euro-Peristat project (29 countries in 2010, N = 5 074 643 births). We also used European Society of Human Reproduction and Embryology (ESHRE) data on assisted conception and single embryo transfer (SET). The impact of MBR on outcomes was studied using meta-analysis techniques with random-effects models to derive pooled risk ratios (pRR) overall and for four groups of country defined by their MBR. We computed population attributable risks (PAR) for these groups. Results In 2010, the average MBR was 16.8 per 1000 women giving birth, ranging from 9.1 (Romania) to 26.5 (Cyprus). Compared to singletons, multiples had a nine-fold increased risk (pRR 9.4, 95% Cl 9.1–9.8) of preterm birth (<37 weeks GA), an almost 12-fold increased risk (pRR 11.7, 95% CI 11.0–12.4) of very preterm birth (<32 weeks GA). Pooled RR were 2.4 (95% Cl 1.5–3.6) for fetal mortality at or after 28 weeks GA and 7.0 (95% Cl 6.1–8.0) for neonatal mortality. PAR of neonatal death and very preterm birth were higher in countries with high MBR compared to low MBR (17.1% (95% CI 13.8–20.2) versus 9.8% (95% Cl 9.6–11.0) for neonatal death and 29.6% (96% CI 28.5–30.6) versus 17.5% (95% CI 15.7–18.3) for very preterm births, respectively). Conclusions Wide variations in MBR and their impact on population outcomes imply that efforts by countries to reduce MBR could improve perinatal outcomes, enabling better long-term child health

Microstructure evolution and thermal stability of rapidly solidified Al-Ni-Co-RE alloy

In the frame of this work, Al-5Ni-1Co-3RE (RE-Rare Earth (Mischmetal)) rapidly solidified ribbons were manufactured and analyzed. The morphology of the as-cast structure, as well as the microstructural features were analyzed by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Thermal stability has been investigated by combination of four point scanning electrical resistivity measurement (ER), differential scanning calorimetry (DSC) and microhardness measurement. From the results we can conclude, that Al-5Ni-1Co-3RE rapidly solidified alloys have good thermal stability due to very slow coarsening kinetics of precipitated particles

Socioeconomic inequalities in stillbirth rates in Europe: measuring the gap using routine data from the Euro-Peristat Project

Background Previous studies have shown that socioeconomic position is inversely associated with stillbirth risk, but the impact on national rates in Europe is not known. We aimed to assess the magnitude of social inequalities in stillbirth rates in European countries using indicators generated from routine monitoring systems. Methods Aggregated data on the number of stillbirths and live births for the year 2010 were collected for three socioeconomic indicators (mothers’ educational level, mothers’ and fathers’ occupational group) from 29 European countries participating in the Euro-Peristat project. Educational categories were coded using the International Standard Classification of Education (ISCED) and analysed as: primary/lower secondary, upper secondary and postsecondary. Parents’ occupations were grouped using International Standard Classification of Occupations (ISCO-08) major groups and then coded into 4 categories: No occupation or student, Skilled/ unskilled workers, Technicians/clerical/service occupations and Managers/professionals. We calculated risk ratios (RR) for stillbirth by each occupational group as well as the percentage population attributable risks using the most advantaged category as the reference (post-secondary education and professional/managerial occupations). Results Data on stillbirth rates by mothers’ education were available in 19 countries and by mothers’ and fathers’ occupations in 13 countries. In countries with these data, the median RR of stillbirth for women with primary and lower secondary education compared to women with postsecondary education was 1.9 (interquartile range (IQR): 1.5 to 2.4) and 1.4 (IQR: 1.2 to 1.6), respectively. For mothers’ occupations, the median RR comparing outcomes among manual workers with managers and professionals was 1.6 (IQR: 1.0–2.1) whereas for fathers’ occupations, the median RR was 1.4 (IQR: 1.2–1.8). When applied to the entire set of countries with data about mothers’ education, 1606 out of 6337 stillbirths (25 %) would not have occurred if stillbirth rates for all women were the same as for women with post-secondary education in their country. Conclusions Data on stillbirths and socioeconomic status from routine systems showed widespread and consistent socioeconomic inequalities in stillbirth rates in Europe. Further research is needed to better understand differences between countries in the magnitude of the socioeconomic gradient

La modification des règles d'enregistrement des naissances vivantes et des mort-nés en France. Quel impact sur la mortalité périnatale?

Blondel Béatrice. La modification des règles d'enregistrement des naissances vivantes et des mort-nés en France. Quel impact sur la mortalité périnatale?. In: Population, 55ᵉ année, n°3, 2000. pp. 623-627

Le système d’information périnatal en France

The French perinatal information system is based on several sources. At the national level, these sources are vital statistics, health certificates on the eighth day which provide data on all live births in each département, national perinatal surveys which provide data on basic indicators on a regular basis and specific issues at each survey, and the Programme de médicalisation du système d’information (PMSI, information system medicalization program) which gives a few indicators on the whole population every year. Registries of congenital anomalies or chilhood impairments are established in the départements or regions. Despite improvements made recently, the information system is still highly inadequate and relatively poor in comparison with that of most other European Union countries. The system’s fragmentation and fragile organization threaten its survival. Moreover, the indicators collected are incomplete or based on populations that are too small for a wide use of data.Le système d’information périnatale français repose sur plusieurs sources. Au niveau national, il comprend les statistiques de l’état civil, les certificats de santé du huitième jour qui fournissent des données sur toutes les naissances vivantes dans chaque département, les enquêtes nationales périnatales qui donnent des informations à intervalles réguliers sur les indicateurs de base et sur des questions spécifiques différentes à chaque enquête et le Programme de médicalisation du système d’information (PMSI) qui offre chaque année quelques indicateurs sur la totalité de la population. Des registres sur les malformations ou sur les handicaps de l’enfant sont implantés dans des départements ou des régions. Malgré des améliorations apportées récemment, le système d’information est encore très insuffisant et relativement pauvre par rapport à la plupart des autres pays de l’Union européenne. Le système est fragmenté, son organisation est fragile et ceci menace sa pérennité. De plus, les indicateurs recueillis sont insuffisants ou fondés sur des populations trop restreintes pour un emploi étendu des données.Blondel Béatrice. Le système d’information périnatal en France. In: Santé, Société et Solidarité, n°1, 2004. Naître en France et au Québec. pp. 159-169

LES CESARIENNES EN FRANCE (SITUATION EN 1995 ET EVOLUTION 1981-1995 (DES GYNECOLOGIE ET OBSTETRIQUE))

NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF