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Care and Outcome of Out‐of‐hospital Deliveries
Author(s) -
Moscovitz Harry C,
Magriples Urania,
Keissling Mark,
Schriver John A
Publication year - 2000
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2000.tb02264.x
Subject(s) - medicine , prenatal care , psychological intervention , logistic regression , population , pregnancy , emergency medicine , pediatrics , intubation , emergency department , obstetrics , surgery , nursing , environmental health , biology , genetics
. Objectives: To identify interventions by paramedics in out‐of‐hospital deliveries and predictors of neonatal outcome. Methods: A prospective case series of consecutive out‐of‐hospital deliveries at Yale‐New Haven Hospital from January 1991 to January 1994. Data describing out‐of‐hospital interventions, demographics, maternal risk factors, and neonatal outcomes were collected from out‐of‐hospital, emergency department (ED), and hospital records. Subgroups defined by source of prenatal care were compared using a multiple logistic regression model to determine predictors of poor neonatal outcome. Results: Ninety‐one patients presented to the hospital after delivery. Paramedics attended 78 (86%) of the cases. Paramedics performed endotracheal intubation in one neonate and supported ventilation in four others. Suctioning and warming of the neonate were documented in 58% and 76%, respectively, and hypothermia was common (47%) in the paramedicattended deliveries. There were 9 neonatal deaths. Eight (89%) of the neonatal deaths were in the group with no prenatal care (p < 0.0001). Lack of prenatal care (RR 304, 95% CI = 5.0 to 18,472) and history of poor prenatal care (RR 22.5, 95% CI = 1.19 to 427) were significant predictors of poor neonatal outcome. Sixteen percent of all study patients and 43% of those with no prenatal care were treated in the ED during their pregnancies. Eighteen percent of the patients had had no prenatal care during previous pregnancies. Conclusions: Paramedics manage labor and delivery of a high‐risk population. Fundamental aspects of care were not universally documented. Lack of prenatal care was associated with high neonatal morbidity and mortality. Nearly half of the mothers who went on to deliver without prenatal obstetric care saw emergency physicians during their pregnancies.