STUDY OBJECTIVE: The objective was to test the hypothesis that easy access to sophisticated hospitals is associated with a reduction in perinatal mortality. DESIGN: The study was a nationwide questionnaire survey of a birth cohort. SUBJECTS: All deliveries greater than 500g weight of singleton live births and stillbirths occurring throughout Greece during April 1983 were included. Completed questionnaires were returned for 10,953 deliveries (8% of total annual registered births in Greece), and data on 10,790 singleton births were analysed, including 127 stillbirths and 137 early neonatal deaths. MEASUREMENTS AND MAIN RESULTS: The questionnaires contained information on demographic characteristics of each parent, mother's reproductive history, and clinical course of pregnancy, labour and perinatal period. Mothers living in big urban centres were compared with the rest of the country. Overall mortality rates were similar but births in the big urban centres were of significantly lower weight due to fetal growth retardation. Logistic regression analysis, taking account of birthweight, parity, maternal age, and maternal education showed that there was an advantage to mothers living in big urban centres, perinatal mortality being 63% higher in the rest of the country (chi 2 = 7.4, p less than 0.01). CONCLUSION: The evidence obtained supports the original hypothesis and suggest that a reduction in the high perinatal mortality rate in Greece may be achieved by restructuring the perinatal services.
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