Obstetric characteristics and neonatal outcome of unplanned out-of-hospital term deliveries: a prospective, case-control study.
OBJECTIVE
To describe the obstetric characteristics and neonatal outcomes in unplanned out-of-hospital deliveries.


METHODS
Obstetric characteristics and neonatal outcomes were compared between 151 consecutive parturients with unplanned, out-of-hospital term deliveries and 151 hospital term deliveries.


RESULTS
Women who delivered out of hospital tended to be older (32 +/- 5.5 vs. 28 +/- 5.0 years, p = 0.046) and less educated (4.4 +/- 5.1 vs. 6.5 +/- 5.0 years, p = 0.005) as compared to women who delivered in the hospital. Unplanned out-of-hospital deliveries resulted in statistically significant higher rate of low-birth-weight newborns (< 2,500 g) (OR= 3.9, 95% CI 2.0-7.7, p<0.001), postpartum hemorrhage (OR = 8.4, 95% CI 1.1-181.1, p = 0.018) and trended for higher rate of manual lysis of retained placenta and membranes (4.0% vs. 0%, p = 0.013). Higher rates of admission to the neonatal intensive care unit due to neonatal complications, such as polycythemia (12.6% vs. 0%, p < 0.001), hypoglycemia (9.3% vs. 0.6%, p = 0.001) and convulsions (3.3% vs. 0%, p = 0.024), were noted in the out-of-hospital delivery group as compared to the controls. Using a multivariable analysis, lower educational level (OR = 0.4, 95% CI 0.3-0.4, p < 0.001), maternal age > 35 (OR = 6.2, 95% CI 2.3-16.7, p < 0.001) and high parity (OR = 7.9, 95% CI 4.9-12.9, p<0.001) were found to be independent risk factors for an unplanned outof hospital delivery.


CONCLUSIONS
Unplanned out-of-hospital birth is an important risk factor for such complications as postpartum hemorrhage, low birth weight and adverse neonatal outcome.
Hadar
Amnon
A
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. hadaram@bgumail.bgu.ac.il
Rabinovich
Alex
A
Sheiner
Eyal
E
Landau
Daniela
D
Hallak
Mordechai
M
Mazor
Moshe
M
D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010298:Parity; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors