Evolution of emergency obstetric care practices and outcomes of Unplanned Out-of-Hospital Deliveries: Insights from a 13-year multicenter prospective study in France.

Resumen

Objective: To analyze emergency physicians’ practices over a 13-year period using national Unplanned Out-of-Hospital Deliveries (UOHDs) cohort, by comparing them to current guidelines, with aim of improving maternal and neonatal outcomes, reducing associated morbidity and mortality and of identifying educational priorities.
Methods : Between October 2011 and June 2024, the management of 3,473 UOHDs was recorded. Data collected from 79 Emergency Medical Services centers across France.
Results: Over time, significant increases were observed in delays from the emergency call center to Mobile Intensive Care Unit (MICU) arrival (p = 0.01), and from birth to placental delivery (p < 0.01). Delays from delivery to hospital arrival remained stable (p = 0.62 for mothers; p = 0.55 for newborns). The use of oxytocin for placental delivery increased (p = 0.01). Conversely, blood glucose measurement (p<0.01) and systematic nasopharyngeal suction (p < 0.01) declined markedly. On site, temperature measurement decreased over time (p < 0.01). Use of thermal protection measures such as hats (p < 0.01), polythene bags (p < 0.01), and blankets (p < 0.01) also decreased, while skin-to-skin contact (p < 0.01) and incubator use (p < 0.01) increased. Notably, the proportion of neonates receiving no thermal protection slightly but significantly rose (p = 0.045).
Conclusions: The regular dissemination of clinical guidelines has contributed to changes in practices and improved maternal and neonatal care. However, progress must be made by reducing response times for Emergency Medical Services, promoting the adoption of use of oxytocin for placental delivery, and combating neonatal hypothermia.