Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
School of Medicine Doctoral Program, University of Tampere, Tampere, Finland.
Acta Obstet Gynecol Scand. 2020 Dec;99(12):1691-1699. doi: 10.1111/aogs.13947. Epub 2020 Jul 29.
Unplanned out-of-hospital deliveries (UOHDs) have earlier been related to higher perinatal mortality and morbidity, but recent research has not paid much attention to them. Our aim was to evaluate the incidence, characteristics, risk factors, and maternal and perinatal mortality and morbidity in UOHDs in Finland.
We conducted a national register study on births, causes of death and congenital anomalies for all live and stillbirths during 1996-2013. The study group included 1420 infants delivered by mothers with UOHDs. The 1 051 139 infants born in hospitals during the study period were the reference group. Data on maternal and delivery characteristics, obstetric procedures, infants' characteristics, neonatal care unit admissions, diagnoses, congenital anomalies and causes of death were collected.
The annual rate of UOHDs increased in 1996-2013 from 46 to 260 per 100 000 deliveries, whereas the number of delivery units decreased from 44 to 29. UOHD infants had five times higher perinatal mortality rates than those delivered in hospitals. The perinatal mortality rate did not change by time in the UOHDs, whereas it diminished among in-hospital deliveries. Maternal morbidity in UOHDs was low. The predictors for UOHDs were delivery after the year 2001, delivery in sparsely populated areas, alcohol, drug abuse and/or smoking during pregnancy, being single, fewer prenatal visits, having delivered earlier and birthweight <2500 g. UOHD was one of the predictors of perinatal morbidity and mortality. Among the UOHD cases, the predictors of perinatal morbidity or mortality included low birthweight and preterm delivery. Time period seemed not to predict morbidity or mortality.
The UOHD rate increased, probably due to multifactorial causes, including living in area with low population density and short duration of labor. UOHD was a significant predictor of perinatal morbidity or mortality, but the numbers were very small. Neonatal morbidity and mortality in UOHDs did not seem to be related to the area or time period of birth.
非计划性院外分娩（UOHD）先前与围产期死亡率和发病率较高有关，但最近的研究并没有过多关注这一点。我们的目的是评估芬兰 UOHD 的发生率、特征、危险因素以及母婴围产期死亡率和发病率。
我们对 1996-2013 年期间所有活产儿和死产儿的出生、死因和先天性畸形进行了全国性的登记研究。研究组包括 1420 名由 UOHD 母亲分娩的婴儿。在此期间，在医院分娩的 1051139 名婴儿为对照组。收集了母亲和分娩特征、产科程序、婴儿特征、新生儿重症监护病房入院、诊断、先天性畸形和死因的数据。
1996-2013 年，UOHD 的年发生率从每 10 万分娩 46 例增加到 260 例，而分娩单位数量从 44 个减少到 29 个。UOHD 婴儿的围产儿死亡率是在医院分娩的婴儿的五倍。UOHD 中的围产儿死亡率并未随时间而变化，而在医院分娩中的围产儿死亡率则有所下降。UOHD 中的产妇发病率较低。UOHD 的预测因素是 2001 年后分娩、人口稀少地区分娩、妊娠期间酗酒、吸毒和/或吸烟、单身、产前检查次数较少、更早分娩和出生体重<2500 克。UOHD 是围产儿发病率和死亡率的预测因素之一。在 UOHD 病例中，围产儿发病率或死亡率的预测因素包括低出生体重和早产。时间段似乎不能预测发病率或死亡率。
UOHD 发生率增加，可能是由于多种因素造成的，包括居住在人口密度低的地区和分娩时间短。UOHD 是围产儿发病率或死亡率的重要预测因素，但数量非常少。UOHD 新生儿的发病率和死亡率似乎与出生地点或时间段无关。
