Maternal risk during pregnancy: a concept analysis.
OBJECTIVE(S) To use the delivery site according to the birth weight as a marker of changes in the referral practices after regionalisation of perinatal care. STUDY DESIGN Analysis of the distribution of low birth weight infants according to the level of care in Rhone-Alpes from 1998 to 2000 and analysis of the birth rate heterogeneity according to the delivery site characteristics. RESULTS The distribution of infants<or=1500 g remained constant at all levels (60% at level 3). That of infants 1500-2000 g born at level 3 dropped in 2000 but raised at levels 1 and 2. For both weight categories, the lower birth rates corresponded to the private, the lower-flow, and the more distant from neonatal intensive care units facilities. For infants<or=1500 g, the level 3 birth rate was four times the level 2 (P=0.0006) and five times the level 1 (P<0.0001) rates. For infants 1500-2000 g, level 3 birth rate was twice the level 2 (P=0.0096) and 3.6 times the level 1 (P<0.0001) rates. Birth rates were always significantly higher in university than in private facilities. CONCLUSION(S) Supervising level 3 is insufficient to show the effect of regionalisation. A more accurate analysis of intermediate-risk referral determinants is needed to reach a more demand/supply adequacy.