Hostname: page-component-848d4c4894-p2v8j Total loading time: 0.001 Render date: 2024-05-14T13:51:34.725Z Has data issue: false hasContentIssue false
  • English
  • Français

Out-of-Hospital Deliveries: A Five-Year Experience

Published online by Cambridge University Press:  28 June 2012

Vincent P. Verdile ,
Gregory Tutsock ,
Paul M. Paris  and
Robert A. Kennedy
Vincent P. Verdile*
Affiliation:
Associate Professor, Department of Emergency Medicine, Albany Medical College, Albany, New York
Gregory Tutsock
Affiliation:
Supervisor, Patient Care Activities, Bureau of Emergency Medical Services, City of Pittsburgh, Department of Public Safety, Pittsburgh, Pennsylvania
Paul M. Paris
Affiliation:
Associate Professor of Medicine, Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Robert A. Kennedy
Affiliation:
Chief, Bureau of Emergency Medical Services, City of Pittsburgh, Department of Public Safety, Pittsburgh, Pennsylvania
*
Associate Professor, Department of Emergency Medicine, 47 New Scotland Avenue, Albany, NY 12208 USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Prehospital providers regularly encounter patients with obstetrical emergencies. This study determined the frequency and outcome of out-of-hospital deliveries in an urban, all advanced life support (ALS) emergency medical services (EMS) system.

Methods:

Retrospective review of all out-of-hospital records that involved women delivering babies in the care of prehospital providers from 1984–1988. The EMS system answered an average of 62,000 calls during the study period. The records of these patients were identified through a computer database.

Results:

A total of 81 out-of-hospital deliveries (1.4/month) occurred during the study years. The average age of the mothers was 24 years, and the average gestation period was 30 weeks. The women had an average of three previous pregnancies and two previous deliveries, and 10 were primagravida. Seventy-two (89%) of the deliveries occurred in the home. The paramedia encountered a variety of obstetrical and neonatal complications in 34% of the patient encounters. Nine neonates were delivered prior to the arrival of the paramedic team. Twenty-four neonates had Apgar scores calculated, and the one- and five-minute scores averaged eight and nine respectively. Five of the mothers had no prenatal care. Maternal complications included four patients noted to be hypertensive with the delivery, nine patients had some degree of vaginal bleeding, and in 33 patients, the prehospital providers did not deliver the placenta in the field. An EMS physician was in attendance for only two of the out-of-hospital deliveries.

Discussion:

In this urban EMS system, out-of-hospital deliveries, especially pre-term deliveries, are a common event. There appears to be a significant number of neonatal complications that confront paramedics. Generally, the paramedics were deficient in their documentation of the neonatal assessment. Continuing educational programs for paramedics should include reviewing normal and complicated vaginal deliveries as well as ALS measures for neonates. Protocols for obstetrical emergencies need to be developed and subjected to quality improvement measures.

Conclusions:

Paramedics, especially those in urban settings, are likely to encounter obstetrical and neonatal emergencies and a significant number of associated complications. Emergency medical services systems and medical directors should have in place continuing educational programs, patient-care protocols, and continuous quality improvement measures to evaluate the care rendered to patients having out-of-hospital deliveries.

Keywords

high-risk obstetricsneonatalobstetricout-of-hospital deliveries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 1 , March 1995 , pp. 10 - 13
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the Sixth Annual Conference of the National Association of EMS Physicians, June 1990, Houston, Texas

References

1. National Center for Health Statistics: Advanced Report of Final Natality Statistics, 1984. Monthly Vital Statistics Report, 1986;35:l–43.Google Scholar
2. National Center for Health Statistics: Advanced Report of Final Natality Statistics, 1985. Monthly Vital Statistics Report, 1987;36:1–43.Google Scholar
3. National Center for Health Statistics: Advanced Report of Final Natality Statistics, 1986, Monthly Vital Statistics Report, 1988;37:1–47.Google Scholar
4. National Center for Health Statistics: Advanced Report of Final Natality Statistics, 1987. Monthly Vital Statistics Report, 1989;38:1–47.Google Scholar
5. National Center for Health Statistics: Advanced Report of Final Natality Statistics, 1988. Monthly Vital Statistics Report, 1990;39:1–47.Google Scholar
6. Personal Communication, Allegheny County Health Department, Pittsburgh, PA.Google Scholar
7. Barnett, WM: Umbilical cord prolapse: A true obstetrical emergency. J Emerg Med 1989;7:149–152.CrossRefGoogle ScholarPubMed
8. Brunette, DD, Sterner, SP: Prehospital and emergency department delivery: A review of eight years experience. Ann Emerg Med 1989;18:1116–1118.CrossRefGoogle ScholarPubMed
9. Higgins, SB: Emergency delivery: Prehospital care, emergency department delivery, perimortum salvage. Emerg Med Clin NA 1987;5:529–539.CrossRefGoogle Scholar
10. Katz, VL, Hansen, AR: Complications in the emergency transport of Pregnant women. South MED J 1990;83:7–10.CrossRefGoogle ScholarPubMed
11.Grant, HD, Murray, RH, Bergeron, JD (eds): Brady Emergency Care, 6th ed. Englewood Clifts, NJ, Brady, 1994.Google Scholar
12. Caroline, NC (ed): Emergency Care In the Street, 4th ed. Boston, Mass., Little Brown and Co., 1991.Google Scholar
13. Caunitz, AM, Huges, JM, Grimes, DA, et al. : Causes of maternal moitality in the United States. Obslet and Gyn 1985;65:605–612.Google Scholar
14. Eskenazi, B, Fenster, L, Sidnet, S: A multivariate analysis of risk factors for pre-eclampsia. JAMA 1991;266:237–241.CrossRefGoogle Scholar
15. Vago, T: Prolapse of the umbilical cord: A method of management. Amer J Obstet Gyn 1970; 7:967–969.CrossRefGoogle Scholar
16. Silver, HM: Acute hypertensive crisis in pregnancy. Med Clin NA 1989;73:623–638.Google ScholarPubMed
17. Verdile, VP, Verdile, AL: Postpartum amaurosis. Ann Emerg Med 1991;20:311–314.CrossRefGoogle ScholarPubMed
18. Paneth, N, Kiely, JL, Wallenstin, S, et al. : The choice of place of delivery, effect of hospital level on mortality in all singleton birth in New York City. AJDC 1987;141:60–64.Google ScholarPubMed
19. Kochenour, JK: Intrapartum obstetric emergencies. Crit Care Clin 1991;7:851–864.CrossRefGoogle ScholarPubMed
20. Tuck, SM, Cardozo, LD, Studd, JW, et al. : Obstetric characteristics in different racial groups. Brit J Obstel Gyn 1983;90:892–897.CrossRefGoogle ScholarPubMed
21. Lamb, FS, Rosner, MS: Neonatal resuscitation. Emerg Med Clin NA 1987;5:541–557.CrossRefGoogle ScholarPubMed
22. Weiner, EE, Gordon, JS, Gilman, BR: Evaluation of a labor and delivery videodisk simulation. Comput Nurs 1993;11:191–196.Google Scholar
23. McCormick, MC, Shapirio, S, Starfield, BH: The regionalization of perinatal services. JAMA 1985;253:799–803.CrossRefGoogle ScholarPubMed
24. Swor, RA (ed). Quality Management in Prehospital Care. St. Louis, Mo., Mosby Lifeline, 1993.Google Scholar
25. Rosthow, VP, Osterweis, N, Bulger, RJ: Medical professional liability and the delivery of obstetrical care. N Engl J Med 1989;321:1057–1060.CrossRefGoogle Scholar
26. Sachs, BP: Is the rising rate of cesarean sections a result of more defensive medicine? In: Rostow, VP, Bulger, RJ, (eds) Medical Professional Liability and the Delivery of Obstetrical Care: An Interdisciplinary Review. Washington, D.C.: National Academy Press 1989; pp 27–40.Google Scholar
27. Goldberg, RJ, Zautecke, JL, Koenigsberg, MD, et al. : A review of prehospital care litigation in a large metropolitan EMS system. Ann Emerg Med 1990; 19:557–561.Google Scholar
28. Soler, JM, Montes, MF, Egol, AB, et al. : The 10-year malpractice experience of a large urban EMS system. Ann Emerg Med 1985;14:982–985.CrossRefGoogle Scholar