Gutvirtz Gil, Wainstock Tamar, Landau Daniella, Sheiner Eyal
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel.
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva POB 653, Israel.
J Clin Med. 2020 Jan 25;9(2):339. doi: 10.3390/jcm9020339.
The unpredictable nature of childbirth infrequently results in unplanned out-of-hospital birth, in a pre-hospital setting. We evaluated the perinatal and long-term outcome of children accidentally born out-of-hospital. This was a population-based analysis of singleton deliveries occurring at a single tertiary hospital. The maternal characteristics and pregnancy outcome of unplanned out-of-hospital births were compared with in-hospital attended deliveries. Long-term cumulative incidence of hospitalizations (up to 18 years) involving respiratory, neurological, endocrine or infectious morbidity were evaluated using Kaplan-Meier survival curves and Cox regression models were used to control for confounders. In total, 243,682 deliveries were included, and 1.5% ( = 3580) were unplanned out-of-hospital births. Most occurred in multiparous women, and about a quarter of these women had inadequate prenatal care. Perinatal mortality rate was significantly higher for out-of-hospital births as compared with in-hospital births (OR = 2.9; 95% CI 2.2-3.8, < 0.001). Kaplan-Meier survival curves demonstrated a significantly lower cumulative incidence of hospitalizations of children born out-of-hospital and the Cox models showed that hospitalization rates involving any of the above morbidities were significantly lower in children born out-of-hospital. While perinatal mortality was higher in unplanned out-of-hospital births, offspring born out-of-hospital showed a lower incidence of hospitalizations involving a variety of morbidities, possibly owing to under-utilization of healthcare services in this population.
分娩的不可预测性偶尔会导致在院前环境中出现意外的院外分娩。我们评估了意外院外出生儿童的围产期和长期结局。这是一项基于人群的单胎分娩分析，研究对象为一家三级医院发生的分娩。将计划外院外分娩的产妇特征和妊娠结局与院内分娩进行比较。使用Kaplan-Meier生存曲线评估了涉及呼吸、神经、内分泌或感染性疾病的住院长期累积发生率（至18岁），并使用Cox回归模型控制混杂因素。总共纳入了243,682例分娩，其中1.5%（=3580例）为计划外院外分娩。大多数发生在经产妇中，并且这些妇女中有约四分之一的产前护理不足。与院内分娩相比，院外分娩的围产期死亡率显著更高（OR = 2.9；95% CI 2.2 - 3.8，P < 0.001）。Kaplan-Meier生存曲线显示院外出生儿童的住院累积发生率显著更低，Cox模型表明院外出生儿童涉及上述任何一种疾病的住院率显著更低。虽然计划外院外分娩的围产期死亡率更高，但院外出生的后代涉及多种疾病的住院发生率更低，这可能是由于该人群医疗服务利用不足所致。
