Unplanned out-of-hospital birth and risk factors of adverse perinatal outcome: findings from a prospective cohort

Abstract

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.

Unplanned out‐of‐hospital deliveries in Finland: A national register study on incidence, characteristics and maternal and infant outcomes

“…1,12,20,21 Prematurity was most strongly associated with adverse infant outcomes of UOHDs, as found in earlier studies. 1,5,10,11,13 Birth during the most recent time period, 2008-2013, and delivery in areas with low population density were associated with an increased the risk of UOHDs but not with perinatal morbidity or mortality associated with UOHDs. Thus, this does not support the suspicion that such adverse events in UOHDs might be associated with increasing distances due to decreased numbers of delivery hospitals.…”

“…1,5,[9][10][11] We assessed risk factors associated with UOHDs in our earlier work and showed that risk factors associated with UOHDs were smoking during pregnancy, short labor, higher number of previous deliveries, single status, a distance from home to the delivery unit of more than 35 km and fewer prenatal visits. 12 One previous study, revealing risk factors for adverse neonatal outcome, 13 found that multiparity, prematurity, maternal pathology and neonatal hypothermia were independent risk factors of neonatal mortality and morbidity.…”

Out-of-maternity deliveries in France: A nationwide population-based study

“…They were most often planned to take place with assistance ("planned delivery") and only 0.1% took place without any assistance [8]. When a mobile emergency service was called, the medical team delivered the newborn in a third of cases [9].…”

Assessment of rewarming methods in unplanned out-of-hospital births from a prospective cohort

“…Out-of-hospital delivery is associated with unfavorable perinatal outcomes and increased mortality [2,5,6], with hypothermia being the most frequently described adverse outcome [1,7,8]. Indeed, hypothermia is recognized as a significant risk factor for mortality under these conditions [9,10]. In low birth weight infants, mortality increases by 28% per 1°C decrease of body temperature from birth to admission in the neonatal intensive care unit [11].…”