[Is the structure of perinatal care in Germany responsible for the less-than-optimal, merely average results in European comparison regarding rates for both infant and maternal mortality as well as rates of premature birth?]

The outcomes of perinatal care in Germany in terms of infant mortality and prematurity rates remain only at the European average. Neither medical factors, such as maternal age, nor socioeconomic data sufficiently explain these differences. Perinatal care in Germany in characterized by a high number of obstetric units with relatively low annual deliveries; almost half of these units are not directly linked to a pediatric department. In contrast, Northern European countries have substantially larger obstectric units in terms of annual deliveries, and these are almost invariably integrated with pediatric departments. This structure of perinatal care is associated with significantly lower prematurity rates - particularly for gestational ages below 28 weeks - as well as reduced infant mortality rates, despite requiring longer travel distances. Consequently, these epidemiological differences should be considered in healthcare planning, and obstetric units should be exclusively organized in conjunction with pediatric departments to optimize outcomes.