背景：周產期區域化醫療網的目標是讓不同需要的母嬰，都可以適時適地獲得適當照護，減少不良出生結果發生。因此，必須有不同地區（尤其是偏遠地區）不同需要（譬如高風險妊娠盛行率）與照護服務使用率的實證數據，才能評估醫療網是否達到預期目標。
目的：一探討產婦居住地與生產地是否在同一縣市，提供周產期醫療網區域劃分參考；二找出哪些縣市是高風險妊娠潛勢地區；三檢視原住民地區孕產婦產前檢查使用率與相關影響因素；四瞭解高風險孕婦沒使用產檢服務的可能原因。
方法：產婦居住地與地區別高風險妊娠指標盛行率來自出生通報檔。產婦生產地與醫療院所來自健保資料庫西醫住院檔資料。統計各鄉鎮市區最多生產醫療院所之縣市來歸屬周產期區域醫療網分區。高風險妊娠指標孕產婦特徵相關指標包括產婦年齡≥35歲、產婦年齡<20歲、第四胎或以上、剖腹產；出生結果相關指標包括出生體重<1000公克與<1500公克、懷孕週數<28週與<32週、雙胞胎或以上。關於原住民地區產檢使用與相關影響因素，以問卷調查新竹縣尖石鄉及五峰鄉婦女。
結果：在368鄉鎮市區中，大多是在所屬行政區縣市生產，只有63個鄉鎮市區主要生產醫療所不是在所屬行政區縣市，大多是臨界縣市的鄉鎮市區或是缺乏產科服務的偏鄉與離島。依照兩個最嚴重的出生結果高風險妊娠指標（出生體重<1000公克與懷孕週數<28週），最高風險縣市分別是南投縣、花蓮縣、臺東縣與苗栗縣。南投縣的趨勢在2004至2010年是下降趨勢(年改變率-11.5%)，在2010至2019年是上升趨勢(年改變率+14.1%)。問卷回收154位婦女217次懷孕生產經歷，五分之三的懷孕是非計畫性懷孕，有12位是第六胎或以上。關於產檢，約十分之一孕婦（22位）第一次產檢是在三個月之後，有三位甚至是在七個月之後，總產檢次數小於四次者有五位。約二成孕婦於懷孕期間持續吸菸，約一成孕婦於懷孕期間持續飲酒。深度訪談顯示未成年未婚懷孕承受很大社會壓力，會影響規律產檢。
結論：本研究發現：傳統使用縣市行政界線劃分周產期醫療網區域在某些縣市不太恰當，應該使用實際實現的產檢與生產醫療院所來劃分區域，才能比較正確規劃責任醫院。未來可以合併幾個鄉鎮市區來分析高風險妊娠的比例與就醫行為，才能比較準確評估目前周產期醫療網是否達到預期目標。原住民地區有許多懷孕屬於非計畫性，且有一些婦女生育六胎或以上，未來應該進一步探討家庭計畫內容，發展出符合文化意涵的家庭計畫宣導內容。

This study used Birth Notification Registry, National Health Insurance claims data and questionnaire to explore the issues related to perinatal regionalization network in Taiwan. The findings of this study indicated that of the 368 townships in Taiwan, most of them the place of delivery was within the hospitals and clinics in the same city/county with place of residence. Only 63 townships the place of delivery was not within the same city/county with place of residence, most of them were in the vicinity between cities/counties or in remote rural areas in which no obstetrics services could be provided. According to two more serious adverse birth outcome indicators (birthweight <1000 g and gestational age <28 weeks), the counties with highest prevalence were Nantou County, Hualien County, Taitung County, and Miaoli County. The trend in Nantou County was first downward from 2004 to 2010 with annual percent change of -11.5% and then upward from 2010 to 2019 with annual percent change of +14.1%. There were 154 women responded the questionnaires on 217 pregnancies. Only three fifths pregnancies were planned and 12 births were sixth or more parity. With regard to the antenatal appointments, one tenth (n=22) pregnancies the first checkup was after first trimester and 3 of them was after seven months. There were 4 pregnancies the total number of antenatal visits was less than 4. Two tenths of pregnancies the mothers were persistently smoking during the pregnancy and one tenth were persistently drinking alcohol. In conclusion, the classification of regions of perinatal regionalization network should use information on actualized utilizations for proper classification of regions for better accountability. Further studies combining townships with similar profiles to understand the utilization behaviors for high-risk pregnancies for better assessing if the present network achieved the expected goal. With regard to the high percentage of unplanned pregnancies and high parities in indigenous areas, further studies on the culture-sensitive content of family planning are needed.

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