Accidental out-of-hospital delivery as an independent risk factor for perinatal mortality.
OBJECTIVE
To determine maternal characteristics and perinatal outcomes of unattended out-of-hospital deliveries.


METHODS
A population-based study including all singleton deliveries between 1988 and 1999. Maternal characteristics and pregnancy outcomes of accidental out-of-hospital births were compared with those of women who delivered in the hospital. Multiple logistic regression analysis was performed to investigate independent risk factors for out-of-hospital deliveries. Another model was constructed to assess the independent risk of out-of-hospital delivery for perinatal mortality.


RESULTS
The incidence of unattended, out-of-hospital deliveries was 2% (2,328/114,938). Multiparity, Bedouin ethnicity and lack of prenatal care were independently associated with out-of-hospital deliveries. Parturients who delivered out of hospital had a significantly lower rate of previous cesarean deliveries. Perinatal mortality was significantly higher among out-of-hospital deliveries, and those newborns were significantly more likely to be small for gestational age as compared to newborns with in-hospital births. In a multivariable model investigating risk factors for perinatal mortality, out-of-hospital delivery was an independent risk factor for perinatal mortality. Other significant risk factors were Bedouin ethnicity and lack of prenatal care.


CONCLUSIONS
Accidental out-of-hospital birth, associated with multiparity, Bedouin ethnicity and lack of prenatal care, is an independent risk factor for perinatal mortality.
Sheiner
Eyal
E
Departments of Obstetrics and Gynecology, Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. sheiner@bgumail.bgu.ac.il
Shoham-Vardi
Ilana
I
Hadar
Amnon
A
Hershkovitz
Reli
R
Sheiner
Einat K
EK
Mazor
Moshe
M
D000059:Accidents / Q000401:mortality / Q000706:statistics & numerical data*; D000328:Adult; D018912:Arabs / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D007585:Jews / Q000706:statistics & numerical data*; D008429:Maternal Welfare / Q000208:ethnology / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology / Q000208:ethnology*; D011295:Prenatal Care / Q000706:statistics & numerical data; D012307:Risk Factors