title: Urgent EMS managed out-of-hospital delivery dispatches in Helsinki.
abstract: BACKGROUND
  The aim of this study was to examine Helsinki Emergency Medical Services (EMS) and hospital records to determine the incidence and possible complications of out-of-hospital deliveries managed by EMS in Helsinki.
  
  
  METHODS
  We retrospectively analysed all urgent ambulance dispatches relating to childbirth in Helsinki from January 1, 2010 to December 31, 2014 with further analysis of hospital records for the out-of-hospital deliveries. Patients were divided in to two groups: those who delivered before reaching hospital and those who did not deliver before reaching hospital and differences between groups were analysed. Deliveries with gestational age of at least 22 + 0 weeks were considered as births in statistical analysis as this is the current national practice.
  
  
  RESULTS
  There were 799 urgent dispatches during the study period. In 102 (12.8 %) of these delivery took place before reaching the hospital. The incidence of EMS managed out-of-hospital delivery was found to be 3.0/1000 births. The annual number of out-of-hospital deliveries attended by EMS increased from 15 in 2010 to 28 in 2014. No stillbirths were reported. Neither maternal or perinatal deaths nor major maternal complications were noted in the study population.
  
  
  CONCLUSIONS
  Out-of-hospital deliveries represent a small minority of EMS calls and remain a challenge to maintaining professional capabilities. Small sample size might have limited the ability of the study to pick up rare complications.
  
  
  CONCLUSIONS
  The amount of out-of-hospital deliveries in Helsinki increased during the five-year study period. There were no maternal or perinatal mortality or major complications resulting in long-term sequelae associated with the EMS-managed out-of-hospital births.
authors.affiliation: Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, PL 340, 00290 HUS, Finland. jussi.pirneskoski@helsinki.fi.
authors.forename: Jussi
authors.identifier: http://orcid.org/0000-0001-9248-2235
authors.initials: J
authors.lastname: Pirneskoski
authors.affiliation: Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, PL 340, 00290 HUS, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Peräjoki
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, PL 140, 00290 HUS, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Nuutila
authors.affiliation: Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, PL 340, 00290 HUS, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kuisma
mesh_terms: D000328:Adult; D001034:Apgar Score; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005387:Finland; D006801:Humans; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014504:Urban Health
keywords: Birth before arrival; EMS; Emergency medical services; Out of hospital birth; Out-of-hospital delivery; Prehospital delivery; Unplanned delivery