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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
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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

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Footnotes

*

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

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