Journal Article Ahead of print
PubMed: 42886579 DOI: 10.1111/aogs.70357
Unplanned out-of-hospital deliveries: Insights from 3473 births of a 13-year prospective cohort study in France.
Acta Obstet Gynecol Scand
Authors: Charlène Duchanois, Cédric Laurent, Kévin Duarte, François Javaudin, Philippe Pes, Agnès Ricard-Hibon, Thomas Bizouard, Nicolas Bounaud, Olivier Morel, Tahar Chouihed
Affiliations
- Department of Emergency Medicine, University Hospital Nancy, INSERM, UMR_S 1116, DCAC, Nancy, France.
- CNRS UMR 7239 LEM3, University Hospital Nancy, Nancy, France.
- INSERM U1433, CIC-P, Nancy University Hospital Nancy, Nancy, France.
- Department of Emergency Medicine, University Hospital Nantes, Nantes, France.
- Medical Informatics Department, University Hospital Nantes, Nantes, France.
- Department of Emergency Medicine, SAMU 95-Pontoise General Hospital, Pontoise, France.
- Department of Emergency Medicine, University Hospital Angers, Angers, France.
- Department of Emergency Medicine, ORU Occitanie, Carcassonne, France.
- Department of Obstetrics and Gynecology, University Hospital Nancy, INSERM U1254, IADI, Nancy, France.
Abstract
INTRODUCTION
Although poorly researched, unplanned out-of-hospital deliveries are considered to carry a high risk of maternal and neonatal complications, with the primary suspected risk factor being the home-to-hospital travel time. The objective of this study was to describe the characteristics of unplanned out-of-hospital deliveries and to identify factors associated with maternal and neonatal complications.
MATERIAL AND METHODS
Data were collected from the French unplanned out-of-hospital deliveries registry (79 of 402 mobile intensive care units). Analysis included 3473 deliveries between October 2011 and June 2024.
RESULTS
Mean women maternal age was 32.0 ± 5.4 years (range 15-49). Median parity was 2.0 (IQR 2.0-3.0). Gestational age was 39.1 ± 2.3 weeks. Most pregnancies were low-risk (84%). Mean home-to-hospital travel time was 20.7 ± 13.6 min (range 0-200), with more than 45 min for only 3% of women (110/3221) and over 1 h for 1% (23/3221). Maternal complications accounted in 8.4% of women (290/3472), placental hemorrhage in 4.5% (156/3471) and maternal death in 0.1% (2/3471). Perinatal complications occurred in 4.4% (149/3393) of all deliveries, with neonatal deaths accounting for 1.1% (38/3456). Among unplanned out-of-hospital deliveries, factors associated with maternal and/or neonatal complications included birth at 32 + 0-33 + 6 weeks of gestation (adjusted OR 2.86, 95% CI 1.69 to 4.83; p < 0.0001), birth before 32 + 0 weeks of gestation (adjusted OR 25.21, 95% CI 12.13 to 52.40; p < 0.0001), and neonatal hypothermia upon hospital admission (adjusted OR 1.74, 95% CI 1.10 to 2.76; p = 0.019). Hypothermia affected 63% of newborns (1256/2002). Unplanned out-of-hospital deliveries prior to mobile intensive care unit arrival were significantly associated with neonatal hypothermia on-site (adjusted OR 2.02, 95% CI 1.57 to 2.61; p < 0.0001) and at hospital admission (adjusted OR 1.56, 95% CI 1.21 to 2.00; p = 0.0005).
CONCLUSIONS
Severe outcomes of unplanned out-of-hospital deliveries were uncommon but did occur. Complications were associated with prematurity and hypothermia, but not with home-to-hospital travel time. These findings highlight the importance of universal prehospital preparedness, with particular attention to early prevention of neonatal hypothermia and initial hemorrhage management.
MeSH
Travel, Pregnancy, Hemorrhage, Parturition, Cohort Studies, Obstetrics, Hypothermia, Gynecology, Risk Factors, Intensive Care Units, Emergency Medical Services