Strehlow Matthew C, Newberry Jennifer A, Bills Corey B, Min Hyeyoun Elise, Evensen Ann E, Leeman Lawrence, Pirrotta Elizabeth A, Rao G V Ramana, Mahadevan S V
Department of Emergency Medicine, Stanford University, Stanford, California, USA.
Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
BMJ Open. 2016 Jul 22;6(7):e011459. doi: 10.1136/bmjopen-2016-011459.
Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).
Prospective observational study.
Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014.
This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a 'pregnancy-related' problem for free-of-charge ambulance transport. Calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival and patients refusing care were excluded.
Emergency medical technician (EMT) interventions, method of delivery and death.
The median age enrolled was 23 years (IQR 21-25). Women were primarily from rural or tribal areas (1550/1684 (92.0%)) and lower economic strata (1177/1684 (69.9%)). Time from initial call to hospital arrival was longer for rural/tribal compared with urban patients (66 min (IQR 51-84) vs 56 min (IQR 42-73), respectively, p<0.0001). EMTs assisted delivery in 44 women, delivering the placenta in 33/44 (75%), performing transabdominal uterine massage in 29/33 (87.9%) and administering oxytocin in none (0%). There were 1411 recorded deliveries. Most women delivered at a hospital (1212/1411 (85.9%)), however 126/1411 (8.9%) delivered at home following hospital discharge. Follow-up rates at 48 hours, 7 days and 42 days were 95.0%, 94.4% and 94.1%, respectively. Four women died, all within 48 hours. The caesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centres were less likely to deliver by caesarean section (OR 0.14 (0.05-0.43)) CONCLUSIONS: Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the healthcare system. Future research and health system planning should focus on strengthening and expanding EMS as a component of emergency obstetric and newborn care (EmONC).
描述由紧急医疗服务（EMS）转运的产科患者的人口统计学特征、管理情况及结局。
前瞻性观察性研究。
印度五个邦，使用一个集中的EMS机构，该机构在2014年转运了310万名孕妇。
本研究纳入了1684名妊娠晚期妇女的便利样本，她们因“与妊娠相关”的问题呼叫免费救护车转运。如果EMS调度员将呼叫分类为“妊娠”“分娩”“流产”或“阵痛”，则视为“与妊娠相关”。排除机构间转运、救护车到达时患者不在场及拒绝治疗的患者。
急救医疗技术员（EMT）的干预措施、分娩方式及死亡情况。
纳入研究的妇女中位年龄为23岁（四分位间距21 - 25岁）。妇女主要来自农村或部落地区（1550/1684（92.0%））及经济较低阶层（1177/1684（69.9%））。农村/部落地区患者从首次呼叫到医院到达的时间比城市患者更长（分别为66分钟（四分位间距51 - 84分钟）和56分钟（四分位间距42 - 73分钟），p<0.0001）。EMT协助44名妇女分娩，其中33/44（75%）娩出胎盘，29/33（87.9%）进行经腹子宫按摩，无一例（0%）使用缩宫素。共记录1411例分娩。大多数妇女在医院分娩（1212/1411（85.9%）），然而126/1411（8.9%）在出院后在家中分娩。48小时、7天和42天的随访率分别为95.0%、94.4%和94.1%。4名妇女死亡，均在48小时内。剖宫产率为8.2%（116/1411）。多因素回归分析显示，与转运至政府初级卫生中心相比，转运至私立医院的妇女剖宫产分娩的可能性较小（比值比0.14（0.05 - 0.43））。结论：印度弱势群体中的孕妇使用免费EMS进行即将到来的分娩，这使其成为医疗保健系统不可或缺的一部分。未来的研究和卫生系统规划应将重点放在加强和扩大EMS作为紧急产科和新生儿护理（EmONC）的一个组成部分上。
