[Missed opportunities of in utero transfer of very preterm births (24-32 weeks gestation) in Aquitaine, 2003-2005].

Objective: Describe and define the factors associated with missed opportunities of an in utero transfer (IUT), defined by by an absence of IUT where there was no counter-indication for a transfer.

Materials And Methods: Multicentric and retrospective cohort study within the Aquitaine perinatal healthcare network from 1st January 2003 to 30th June 2005 on deliveries between 24 and 32 weeks gestation, depending on whether the woman initially followed care in level I or II facilities benefited from an IUT at a level III facility or not. associated with missed opportunities of IUT were analysed by a logistic regression.

Results: Five hundred and twelve deliveries, eligible to deliver in level III facilities, were included in the study: 273 after an IUT and 239 in a level I or II maternity hospitals out of which 18% are defined as a missed opportunity of an in utero transfer. The multivariate analysis did not show a link between missed opportunities of an in utero transfer and the characteristics of maternities: status, size, level of care and distance from a level III facility. Only the delivery term appears to be linked to a missed opportunity of an in utero transfer (p=0.01): 32 weeks gestation versus 26-29 weeks gestation (RC=6.53; IC(95%): 2.00-21.25). While managing the delivery after 31 weeks gestation is considered suitable in a level IIb facility, the delivery term is no longer statistically related to a missed opportunity.

Conclusion: This study serves as a first analysis of the Aquitaine perinatal healthcare network. It shows that missed opportunities of IUT does not seem to be linked to characteristics of maternities but seems to be linked to deliveries after 31 weeks gestation in level IIb facilities.