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Objectives: To compare evolution and characteristics of in utero transfers (IUT) in Basse-Normandie area, France, between 2004 and 2008, and to describe characteristics of IUT in 2008., Materials and Methods: Analysis of data from the IUT registry, collected prospectively since 2004., Results: An average of five IUT per week was observed. The rate of IUT regularly increased (P=0.003) and reached 16.2 per 1000 pregnancies in 2008. Extra network IUT decreased steadily (P=0.04). For level 3 units, the proportion of IUT from level 2 units increased (P<10(-3)). Before 32 weeks of gestational age, all IUT were done towards a level 3 unit. Median time between IUT and delivery and caesarean section rates were variable according to IUT indication (for threats of premature delivery, respectively 5 days and 23.3%). The rate of retransfer towards initial unit of towards a birth site of relevant level was 5.3%., Conclusion: The IUT registry gives useful information on evolution and characteristics of IUT in our area. An increased regionalisation and more frequent adequate IUT were observed. The registry must now serve as a basis for practices assessment., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objective: To describe specific clinical practices in France in 2004-2005 based on data from the Audipog sentinel network., Patients and Methods: The database for 2004 and 2005 covers 71406 pregnancies from 86 maternity units throughout the year. We constructed a random subsample each year by including only the births occurring during a single month for each maternity ward. Our study therefore analyzes 6987 pregnancies in 2004 and 7648 pregnancies in 2005., Results: Among the very preterm (<33 weeks of gestation) infants from multiple pregnancies, 77.4% were born in level 3 hospitals in 2000-2001, and only 44.9% in 2004-2005 (p<0.0001). Among the very preterm infants from singleton pregnancies, the percentage born in level 3 maternity hospitals rose between 1996-1997 and 2004-2005 (55% versus 73%; p=0.001). The rate of corticosteroid therapy before delivery among very preterm infants did not change significantly between 2000 and 2005 (p=0.58). The cesarean rate rose from 14% in 1994 to 20.0% in 2005. The percentage of actively managed third stages of labor increased from 1994-1995 to 2005 (6.2% versus 31.3%). Fewer episiotomies were performed: 56% in 1994-1995 and 41.3% in 2005. Exclusive breast-feeding rose from 51.2% in 2000-2001 to 58.5% in 2005 (p<0.0001). Early discharge increased between 1994-1995 and 2005 (p<0.0001)., Discussion and Conclusion: Indicators monitoring implementation of some of the national clinical practice guidelines have improved slightly over time, although most often before the publication of these guidelines.

Unlabelled: In France the organization of the care in perinatality is governed by the decrees of October 1998 and was specified by the "plan périnatalité" 2005-2007. This organization allowed an operation in network, declined in a variable way according to areas. In this context, the group of the paediatricians in Languedoc-Roussillon took concrete action of harmonization of the reference frames of care of paediatrics in maternity., Methods: The methodology installation since 2001 lies on the active participation of many paediatricians of the Languedoc-Roussillon region, pledge of an appropriation of these reference frames by the professionals. It relies upon a rigorous process of drafting and validation, and on the use of the data processing tool for the drafting and the diffusion via Internet of these reference frames., Results: In June 2006, 60 reference frames were placed at the disposal of the professionals who intervened with the children in maternity (paediatricians, midwifes, nursery nurses). The paediatricians taking part in the drafting of these regional reference frames accounted for 43% of the paediatricians exerting in maternity of Languedoc-Roussillon. The majority (77%) of the establishments of birth of the area were represented, whatever the level (1, 2 or 3)., Conclusion: We showed that paediatricians could organize themselves to write a great number of reference frames contributing to the improvement of the quality of the care, and harmonization of the practices within the perinatal network.

Objective: To study trends in the main indicators of health, medical practice and risk factors in France. Population and method. A sample of all births during one week was set up in 1995 (N=13,318), 1998 (N=13,718) et 2003 (N=14,737). We compared data from these three years., Results: Between 1995 and 2003, there was an increase in maternal age, a development of some characteristics of care (HIV screening procedure, maternal serum screening of Down syndrome, in utero transfers) and an increase in the proportion of caesarean sections, epidurals and spinal anesthesia. The proportion of livebirths before 37 weeks of gestation and the proportion of newborns under 2,500 g slightly increased but the differences were mainly between 1995 et 1998. In 2003, obstetrician gynecologists were the main care providers during pregnancy. However 24.3% of women had their first visit with a general practitioner. For the following visits, 15.4% of women had seen a GP at least once and 26.9% had seen a midwife in maternity unit at least once., Conclusion: Because of the trends in obstetrical practice and organisation of services, routine national perinatal surveys are useful to show major changes and yield quick answers to specific questions.

Background: The purpose of this study was to describe child deliveries in French Guyana and describe changes in perinatal mortality in different population groups between 1992 and 1999., Material and Methods: All deliveries in health centers and maternity wards in French Guyana between January 1, 1992 and December 31, 1999 were included in the study. Social, demographic, and clinical data were collected at the time of delivery. Infants with a birth weight of 500 g or term 22 weeks were included., Results: From 1992 to 1995, the number of deliveries in health centers declined 5.7% and the number in public maternity wards increased 69.7%. The same trend was observed in 1998 - 1999 (2.4% and 85.7% respectively), an expression of the policy of antenatal referral implemented by the network of childbirth professionals. Perinatal mortality decreased significantly between 1995 and 1998 from 35.4 to 15.2 for the Creole population (p=0.06), from 46 to 16.5 for the Black-Marron Surinam population (p<0.0007), and from 36 to 10.2 for the Black-Marron French population (p<0.009). This drop in mortality in high-risk population groups may have contributed to the overall decline in perinatal mortality observed over the study period. The rate of preterm birth remained stable (at 13.5%) and the proportion of low-weight infants increased only slightly (12.8% to 13.7%). Mortality among preterm infants declined considerably, undoubtedly because of improved neonatal intensive care., Conclusion: Despite significant improvement, the perinatal mortality in French Guyana (18.9 in 1999) remains almost three times that in metropolitan France (7.4 in 1999). The mothers are young (17% aged less than 20 years) and the proportion of primiparous and grand multiparous mothers is high. With the absence or insufficiency of prenatal care, the problem of perinatal mortality remains a public health priority and challenge in French Guyana.

Advances in neonatology have been consistent in recent years, both from practical and theoretical points of view. Improved outcome is the result of major developments in neonatal intensive care, but also of the improved organization of perinatal care. Recent concepts on the inflammatory mechanisms of preterm labor and periventricular leukomalacia are opening a new area for preventive intervention. The observed association between the occurrence of diseases such as hypertension in adulthood and intrauterine growth retardation offers a particular insight into the long term programming of physiologic regulations in the fetus. At the bedside, advances in neonatal intensive care have been significant, especially in treating neonatal respiratory failure. This review will focus on recent developments in premature anemia, and in fluid-electrolyte therapy in very low infant birth weights, as both topics have been less frequently reviewed in the pediatric literature. Finally, ethical issues have deserved considerable attention, such as therapeutic intervention in extremely low birth weight infants, decision-taking, and practices in withholding or withdrawing therapy during neonatal intensive care, along with the need for long term follow up and assistance to the patients and their families.

Three periods are described. The first is the period of perinatality from 1971 to 1981 during which the precise objective was to reduce perinatal mortality and morbidity based on actions proposed after cost-effectiveness analysis and early surveys in France to evaluate the effect of these actions. This plan allowed a new policy including prevention of prematurity and improvement in delivery conditions. National surveys have shown a reduction in prematurity rates and perinatal mortality. The second period was a wait-and-see period with the abandon of national actions, but also a transfer of responsibility for perinatal health to the different departments. Certain departments developed perinatal actions:actions in Martinique and Guadeloupe are described together with the early audit on perinatal care in Seine-Saint-Denis. The third period, the current period, began in 1994 when the government proposed a new perinatality plan based on a new perception of maternal mortality risk and a come back of the idea of a collective approach to safe birth.