Unplanned out-of-hospital deliveries: Insights from 3473 births of a 13-year prospective cohort study in 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.