THE REGIONALIZATION OF PERINATAL-CARE IN FRANCE - DESCRIPTION OF A MISSING POLICY

This paper reviews published data on the organization and evaluation o f regionalized perinatal care programs in countries where they exist a nd describes those elements presently lacking in France. The advantage of maternal compared to neonatal transport is described vis-85-vis it s effect on perinatal deaths as well as neonatal and developmental han dicaps, Most studies describe a major advantage of maternal transfers, with less perinatal deaths (including stillbirths and neonatal deaths ) and lower rates of severe developmental handicaps, In contrast, Fren ch publications show that widespread regionalization of perinatal care does not exist in spite of proposals advocating this concept made mor e than 20 years ago. Thus, many deliveries of less than 33 weeks gesta tion length or/and less than 1500 g birthweight take place in maternit y sites without adequate neonatal care, despite ample evidence that su ch infants are at much greater risk of perinatal death or severe handi caps at 2 years of age after transfer than if they had been born in a perinatal center, For these reasons, professional organizations in Fra nce should choose to implement a policy of maternal transfers as a maj or effort in the near future.