Rodie Vanessa A, Thomson Andrew J, Norman Jane E
Department of Obstetrics and Gynaecology, University of Glasgow, 10 Alexandria Parade, Glasgow G31 2ER, Scotland, United Kingdom.
Acta Obstet Gynecol Scand. 2002 Jan;81(1):50-4. doi: 10.1046/j.0001-6349.2001.00420.x.
Accidental out-of-hospital (OHD) deliveries are associated with high rates of perinatal morbidity and mortality. The ability of health care workers to identify women at risk of out-of-hospital delivery is limited. The purpose of this study was to determine the prevalence of these deliveries in our population and to quantify the neonatal morbidity and mortality associated with such births. Further we aimed to determine whether women at risk of accidental out-of-hospital delivery in our population could be identified antenatally.
A retrospective case-control study was performed. Women who delivered accidentally out-of-hospital in our catchment area between January 1995 and March 1999 were identified (cases) and compared with women who delivered in hospital following spontaneous labor (controls). Outcome measures included maternal demographic characteristics, obstetric features and neonatal outcome.
In the study period, 117 women delivering 121 babies were identified who delivered accidentally out-of-hospital, (0.6% of all deliveries registered at the hospital). Women who delivered before arrival at hospital were more likely to be of greater parity, unbooked, late bookers and/or poor attenders for antenatal care. Gestation at delivery, duration of labor and birthweight were less in the out-of-hospital delivery group compared with the control group. The rate of perineal suturing was lower for cases than controls. Babies who were delivered accidentally out-of-hospital were more likely to require admission to the neonatal unit and had a higher perinatal mortality rate than controls (51.7 versus 8.6/1000 deliveries, respectively).
Accidental out-of-hospital deliveries account for less than 1% of deliveries in our population, but are associated with significant perinatal morbidity and mortality. Women should be educated regarding the importance of both antenatal care and a planned delivery. Since the majority of women who deliver accidentally out-of hospital are parous, there is an opportunity to do this in a previous confinement.
院外意外分娩与围产期高发病率和死亡率相关。医护人员识别有院外分娩风险的女性的能力有限。本研究的目的是确定我院人群中此类分娩的发生率，并量化与此类分娩相关的新生儿发病率和死亡率。此外，我们旨在确定我院人群中有意外院外分娩风险的女性是否可在产前被识别。
进行了一项回顾性病例对照研究。确定了1995年1月至1999年3月在我院辖区内意外院外分娩的女性（病例组），并与自然分娩后在医院分娩的女性（对照组）进行比较。观察指标包括产妇人口统计学特征、产科特征和新生儿结局。
在研究期间，共识别出117名分娩121名婴儿的女性意外院外分娩（占医院登记分娩总数的0.6%）。在到达医院前分娩的女性更可能是经产妇、未登记、登记晚和/或产前检查不规律者。与对照组相比，院外分娩组的分娩孕周、产程和出生体重较低。病例组的会阴缝合率低于对照组。意外院外分娩的婴儿更可能需要入住新生儿病房，围产期死亡率高于对照组（分别为51.7/1000例分娩和8.6/1000例分娩）。
意外院外分娩在我院人群中占分娩总数不到1%，但与显著的围产期发病率和死亡率相关。应教育女性了解产前检查和计划分娩的重要性。由于大多数意外院外分娩的女性是经产妇，因此有机会在其前次分娩时进行此类教育。
