Background In France, while most babies are delivered at hospital, emergency medical services (EMS) weekly manage calls for unplanned out-of-hospital births. The objective of our study was to describe neonatal morbidity and mortality, defined as death or neonatal intensive care unit hospitalization at Day 7, in a prospective multicentric cohort of unplanned out-of-hospital births. Methods We prospectively analyzed out-of-hospital births from 25 prehospital EMS units in France. The primary outcome was neonatal morbidity and mortality, and the secondary outcome was risk factors associated with neonatal morbidity and mortality. A univariate logistic regression was first made, followed by a multivariate logistic regression with backward selection. Results From October 2011 to August 2018, a total of 1670 unplanned out-of-hospital births were included. Of these, 1652 (99.2%) were singleton and 1537 (93.5%) had prenatal care. Maternal mean age of the study population was 30 ± 5.5 (range 15 to 48). The majority of women were multiparous, but 13% were nulliparous. Overall, 45.3% of these unplanned out-of-hospital births were medically-driven, either by phone during medical regulation (12.5%) or on scene by the prehospital emergency medical service units (32.9%). The prevalence of neonatal morbidity and mortality was 6.3% ( n = 106) after an unplanned out-of-hospital birth (death before Day 7: n = 20; 1.2%). The multivariate logistic regression found that multiparity (adjusted Odds Ratio = 70.7 [4.7–1062]), prematurity (adjusted Odds Ratio = 6.7 [2.1–21.4]), maternal pathology (adjusted Odds Ratio = 2.8 [1.0–7.5]) and hypothermia (adjusted Odds Ratio = 2.8 [1.1–7.6]) were independent predictive factors of neonatal morbidity and mortality. Conclusions Our study assessed for the first time risk factors for adverse perinatal outcome in a large and multicenter cohort of unplanned out-of-hospital births. We have to improve temperature management in the out-of-hospital field and future trials are required to investigate strategies to optimize newborns management in the prehospital area. Electronic supplementary material The online version of this article (10.1186/s13049-019-0600-z) contains supplementary material, which is available to authorized users.

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La Société française de médecine d'urgence a élaboré en 2016 des recommandations formalisées d'experts définissant le premier niveau de compétence en échographie clinique en médecine d'urgence. Ce niveau est maintenant complété par un deuxième niveau correspondant à une pratique plus avancée utilisant des techniques non envisagées dans le premier niveau comme l'utilisation du Doppler et nécessitant aussi une pratique et une formation plus poussées. Des champs déjà présents dans le premier référentiel sont complétés, et de nouveaux champs sont envisagés. La méthodologie utilisée est issue de la méthode « Recommandations par consensus formalisé » publiée par la Haute Autorité de santé et de la méthode Delphi pour quantifier l'accord professionnel. Ce choix a été fait devant l'insuffisance de littérature de fort niveau de preuve dans certaines thématiques et de l'existence de controverses. Ce document présente les items jugés appropriés et inappropriés par les cotateurs. Ces recommandations définissent un deuxième niveau de compétence en ECMU.

BackgroundPoint-of-Care Ultrasound (PoCUS) is recommended by emergency medicine societies for the detection of hydronephrosis. Training of certified Emergency Physicians (EP) without prior ultrasound experience remains debated. We investigate performance of a brief training session for the detection of hydronephrosis with PoCUS performed by EP without previous ultrasound experience.Patients and methodsThis was a prospective observational study of a convenience sample of patients older than 18 years with presumed renal colic, acute pyelonephritis or documented acute renal failure. Exclusion criteria were pregnancy and documented end of life.After inclusion and informed consent, a PoCUS was performed. A radiologist’s renal ultrasound (RRUS) was then conducted, the radiologist being blind to PoCUS result.The objective was to determine the diagnostic performance of PoCUS performed by EP for the detection of hydronephrosis using RRUS as gold standard.ResultsSix EP participated in this study. 55 patients were included, five secondary excluded for lack of RRUS. Age was 47 ± 22 years, sex ratio 1. Hydronephrosis prevalence was 38% (CI 95% [26–52%]). Sensitivity of PoCUS was 100% (CI 95% [82–100%]) while its specificity was 71% (CI 95% [52–86%]) with a NPV of 100% (CI 95% [85–100%]) and a 68% (CI 95% [48–84%]) PPV. Kappa coefficient was 0.65 (CI 95% [0.45–0.85]).DiscussionWe demonstrated that a short training program enables EP without previous ultrasound skills to rule out hydronephrosis with satisfactory performances. The main limitation was the absence of collection of the number of PoCUS by EP. After this didactic course, an experiential phase must be carried out.