[Impact of precariousness on quality of prenatal detection: Lariboisière hospital experience in Paris]

Abstract

Context: The objective of our study was to estimate the impact of the precariousness on the quality of the care in antenatal diagnosis of the patients followed to Lariboisière (Parisian service of gynaecology obstetrics situated in a district of the capital discriminated socially) over a period of 3 months.

Patients: All the patients undergoing a prenatal diagnosis consultation in Lariboisière Hospital between February and April 2008. Patients were split in two groups according to their precariousness (economic or psychosocial) or not. Criteria studied were: initial purpose of the prenatal consultation, quality of the first trimester ultrasound exam, access to the integral calculus in Down Syndrome detection, lateness of care between the diagnosis and the prenatal consultation. The second part of this analysis was to evaluate if precariousness was associated with organizational problem in prenatal diagnosis.

Results: Fifty-nine patients were included: 29 (49%) were identified as being in a precariousness situation. The initial purpose of the consultation was the same in the two groups. Precariousness was associated to organizational problems for the prenatal diagnosis consultation (72 vs. 47%, P=0.004). Thirty-five patients (59%) have met organizational problems for the prenatal diagnosis consultation. Were associated to organizational problems: precariousness (60% vs. 33%, P=0.04), low education level (86 vs. 54%, P=0.007) and single mother (23% vs. 0%, P=0.001).

Conclusion: This work shows the negative impact of precariousness on the prenatal diagnosis. Prevention may improve the information and the quality of care given to these patients.