School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia.
College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
BMJ Open. 2018 Mar 14;8(3):e019328. doi: 10.1136/bmjopen-2017-019328.
To determine incidence, associated factors, outcomes and geographical occurrence of born before arrival (BBA) in New South Wales, Australia.
A linked population data study involving population-based surveillance systems was undertaken for the years 2000-2011.
New South Wales, Australia.
All women who underwent BBA compared with women who birthed in hospital/birth centre settings.
During the time period, there were 1 097 653 births and a BBA rate of 4.6 per 1000 births. The BBA rate changed from 4.2 to 4.8 per 1000 births over time (p=0.06). Neonates BBA were more likely to be premature (12.5% compared with 7.3%), of lower birth weight (209.8 g mean difference) and/or be admitted to a special care nursery or neonatal intensive care unit (20.6% compared with 15.6%). The perinatal mortality rate was significantly higher in the BBA cohort (34.6 compared with 9.3 per 1000 births). Women in the BBA cohort were more likely to be in the lowest socioeconomic decile, multiparous, have higher rates of smoking (30.5% compared with 13.8%) and more likely to suffer a postpartum haemorrhage requiring transfusion than the non-BBA cohort (1.5% compared with 0.7%). The most commonly occurring complications for neonates were suspected infection (6.9%), hypothermia (6.9%), respiratory distress (5.4%), congenital abnormality (4.0%) and neonatal withdrawal symptoms (2.4%). BBA more commonly occurred in geographical areas where the distance to a maternity unit is >2 hours drive and in coastal regions where there is also a high rate of homebirth.
BBA occurs more frequently in multiparous women of lower socioeconomic status. There potentially is an effect of geography on the occurrence of BBA, as geographical area of high homebirth and BBA coexists, indicating that freebirth followed by an unplanned transfer to hospital may be occurring.
在澳大利亚新南威尔士州，确定出生前抵达（BBA）的发生率、相关因素、结局和地理分布情况。
本研究采用基于人群的监测系统进行了一项人群数据关联研究，时间范围为 2000 年至 2011 年。
澳大利亚新南威尔士州。
所有 BBA 产妇与在医院/分娩中心分娩的产妇进行比较。
在此期间，共有 1097653 例分娩，BBA 发生率为每 1000 例活产 4.6 例。BBA 发生率随时间从 4.2 增加到 4.8 （p=0.06）。BBA 新生儿更有可能早产（12.5%比 7.3%）、出生体重较低（平均差异 209.8g）和/或入住特别护理室或新生儿重症监护室（20.6%比 15.6%）。BBA 组围产儿死亡率明显更高（34.6 比每 1000 例活产 9.3 例）。BBA 组产妇更有可能处于最低社会经济阶层、多产、吸烟率更高（30.5%比 13.8%），且比非 BBA 组更有可能发生需要输血的产后出血（1.5%比 0.7%）。新生儿最常见的并发症是疑似感染（6.9%）、低体温（6.9%）、呼吸窘迫（5.4%）、先天性异常（4.0%）和新生儿戒断症状（2.4%）。BBA 更常见于距离产科单位超过 2 小时车程的地理区域和沿海地区，这些地区的家庭分娩率也很高。
BBA 更常发生于社会经济地位较低的多产妇。地理因素可能对 BBA 的发生有影响，因为高家庭分娩和 BBA 共存的地理区域表明，可能正在发生自由分娩后无计划转院的情况。
