Pôle de la Femme de la Mère et de l'Enfant, CHU Brest, Brest, France.
Acta Paediatr. 2013 Apr;102(4):e174-7. doi: 10.1111/apa.12156. Epub 2013 Jan 28.
To determine risk factors for accidental out-of-hospital deliveries (OHDs), which represent 0.5% of live births in France and are associated with poor neonatal outcomes.
This retrospective case-control study assessed accidental OHDs that occurred in the Finistère District (Brittany, France) between January 2007 and December 2009. For each OHD case, two controls were randomly selected. Outcome measures included maternal demographics, obstetric characteristics and neonatal outcomes.
During the study period, accidental OHDs accounted for 0.42% of all births; 76 accidental OHDs were included in the analysis. Multivariate analysis found four independent risk factors for accidental OHD: multiparity [OR: 8.84 (3.22-24.29)], unemployment [OR: 4.99 (1.85-13.47)], lack of or poor antenatal care [OR: 9.00 (2.41-33.72)] and a travel time >45 min from home to the delivery unit [OR: 6.18 (1.33-28.65) versus < 15 min]. Significantly more newborns from the OHD group required admission to the neonatal unit (p = 0.04), but accidental OHD was not significantly associated with prematurity or low birth weight.
Four risk factors for accidental OHD were identified. Setting up an anonymous registry of OHD cases could improve our knowledge and screening of women at risk.
确定意外院外分娩（OHD）的风险因素，OHD 在法国占活产儿的 0.5%，与新生儿结局不良有关。
本回顾性病例对照研究评估了 2007 年 1 月至 2009 年 12 月期间在法国布列塔尼菲尼斯泰尔地区发生的意外 OHD。为每个 OHD 病例随机选择 2 个对照。结局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，意外 OHD 占所有分娩的 0.42%；共纳入 76 例意外 OHD 进行分析。多变量分析发现意外 OHD 的四个独立风险因素：多胎产次[OR：8.84（3.22-24.29）]、失业[OR：4.99（1.85-13.47）]、产前保健不足或不良[OR：9.00（2.41-33.72）]和从家到分娩单位的旅行时间>45 分钟[OR：6.18（1.33-28.65）vs <15 分钟]。来自 OHD 组的新生儿需要入住新生儿病房的比例显著更高（p=0.04），但意外 OHD 与早产或低出生体重无关。
确定了意外 OHD 的四个风险因素。建立意外 OHD 病例的匿名登记册可以提高我们对风险妇女的认识和筛查。
