Very preterm birth before arrival at hospital

Boland, Rosemarie A; Davis, Peter G; Dawson, Jennifer A; Stewart, Michael J.; Smith, J.; Doyle, Lex W.

doi:10.1111/ajo.12690

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…The increase in risk for fetus and newborns is well known [6,[31][32][33], Our results for hypothermia [2,3,33], polycythemia [2] and neonatal hospitalizations [33] are similar to those found in other studies. An increase in perinatal mortality was also reported by other studies [20,34], which seems consistent with the increase in risks of stillbirths and in-hospital neonatal deaths observed in the present study. However, the risk of maternal mortality has rarely been studied.…”

Section: Level Of Urbanizationsupporting

confidence: 93%

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

et al. 2020

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Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.

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Section: Level Of Urbanizationsupporting

confidence: 93%

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

et al. 2020

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“…In this large national register study, we found that in recent years The annual UOHD rate in our study population was higher than in earlier studies in Finland (1.0-2.5 per 1000 births 4 ) and Norway (6.8 per 1000 births 1 ). In Finland, the annual rate of UOHDs increased significantly over the study period, with a similar trend throughout UOHDs are more likely to involve mothers who are younger 4,10,18 or older, 1,4,19 are unmarried, TA B L E 2 Risk factor analysis for unplanned out-of-hospital deliveries or a lower socioeconomic status, 6,18,20,21 have a lack of or less access to prenatal care, 2,3,9,18,20,22 have more previous deliveries, [1][2][3][4]6,9,[18][19][20][21][22] have fewer previous cesarean deliveries, 22 have lower GA at delivery, 1,2,4,6,10,18 and experience shorter duration of labor. 2,12 Our findings are in line with previous studies.…”

Section: Discussionmentioning

confidence: 69%

“…UOHDs carry an increased risk of perinatal and neonatal mortality, [1][2][3][4][5][6][7][8][9] including infants born preterm and low birthweight. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Ovaskainen

Ojala

Tihtonen

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Unplanned out-of-hospital deliveries (UOHDs) have earlier been related to higher perinatal mortality and morbidity, but recent research has not paid much attention to them. Our aim was to evaluate the incidence, characteristics, risk factors, and maternal and perinatal mortality and morbidity in UOHDs in Finland. Material and methods: We conducted a national register study on births, causes of death and congenital anomalies for all live and stillbirths during 1996-2013. The study group included 1420 infants delivered by mothers with UOHDs. The 1 051 139 infants born in hospitals during the study period were the reference group. Data on maternal and delivery characteristics, obstetric procedures, infants' characteristics, neonatal care unit admissions, diagnoses, congenital anomalies and causes of death were collected. Results: The annual rate of UOHDs increased in 1996-2013 from 46 to 260 per 100 000 deliveries, whereas the number of delivery units decreased from 44 to 29. UOHD infants had five times higher perinatal mortality rates than those delivered in hospitals. The perinatal mortality rate did not change by time in the UOHDs, whereas it diminished among in-hospital deliveries. Maternal morbidity in UOHDs was low. The predictors for UOHDs were delivery after the year 2001, delivery in sparsely populated areas, alcohol, drug abuse and/or smoking during pregnancy, being single, fewer prenatal visits, having delivered earlier and birthweight <2500 g. UOHD was one of the predictors of perinatal morbidity and mortality. Among the UOHD cases, the predictors of perinatal morbidity or mortality included low birthweight and preterm delivery. Time period seemed not to predict morbidity or mortality. Conclusions: The UOHD rate increased, probably due to multifactorial causes, including living in area with low population density and short duration of labor. UOHD was a significant predictor of perinatal morbidity or mortality, but the numbers were very small. Neonatal morbidity and mortality in UOHDs did not seem to be related to the area or time period of birth.

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“…One Australian study reported that 11% of women attended by EMTs during labour gave birth before arriving at hospital; of these, 27% were recorded with antenatal and/or intrapartum complications, while 22% of the babies were recorded with an Apgar score lower than 7 (Flanagan, Lord, & Barnes, ). Risk factors associated with both maternal and neonatal outcomes in unplanned out‐of‐hospital births include maternal characteristics (young maternal age, low socio‐economic status, immigrant background, smoking), pregnancy‐related factors (multiparity, placental conditions, low birthweight, prematurity, infections, concealed pregnancy) and poor antenatal care (Boland et al, ; Engjom, Morken, Høydahl, Norheim, & Klungsøyr, ; Gunnarsson, Fasting, Skogvoll, Smárason, & Salvesen, ; Jones et al, ; Nguyen et al, ; Unterscheider et al, ).…”

Section: Introductionmentioning

confidence: 99%

Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

et al. 2019

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AimTo explore emergency medical technicians' experiences with unplanned births outside institutions.DesignA qualitative interview study.MethodsIndividual semi‐structured interviews with 12 emergency medical technicians in Norway. Systematic text condensation was used to analyse the data material.ResultsAnalysis showed that there is a mismatch between society's expectations about emergency medical technicians and the reality they encounter in out‐of‐hospital maternity care, that emergency medical technicians experience a general lack of training in caring for labouring women and that poor communication with other health professions challenges patient safety. The participants expressed how they do their best in caring for both mother and child, in spite of a lack of education, training and competence in assisting labouring women.

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Very preterm birth before arrival at hospital

Abstract: Very preterm birth before arrival is more common in teenagers and is associated with significantly increased risks of perinatal and infant mortality compared with birth in a hospital.

Cited by 13 publications

References 20 publications

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

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

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

Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

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