UMEM Educational Pearls

Category: EMS

Title: Prehospital obstetric events

Keywords: delivery, neonatal, OB, contractions (PubMed Search)

Posted: 5/15/2024 by Jennifer Guyther, MD (Updated: 5/25/2024)
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Maternal morbidity continues to increase in the US with a mortality rate in 2021 of 39.2 deaths/100,000 live births.  There has been an intense focus on training and quality improvement within hospitals, but not much has changed in the prehospital education arena.  This study aimed to quantify the complications encountered by EMS clinicians.  

In the 2018-2019 EMS dataset used, there were a total of 56,735,977 EMS activations which included 8641 out of hospital deliveries, 1712 documented delivery complications and 5749 records of newborns.

1% of the out of hospital deliveries had a documented complication for the mother.  Of these complications, 94% were for hemorrhage, 6% for abnormal presentation, 0.2% for shoulder dystocia, and 0.4% for nuchal cord.  

Few patients had medications given, including 0.4% receiving oxytocin.  no patients received prehospital blood transfusion or TXA.  Of note, in the years since this data was obtained, TXA and whole blood have started to appear on more medic units, but it is still not necessarily commonplace.

Bottom line: While still rare, prehospital delivery does occur and EMS should be prepared for any possible complications.  Medical directors should look at their jurisdictional/state protocols to see if oxytocin/TXA or whole blood should be included (if not already available).  EMS clinicians should be educated on up to date management of OB emergencies.

References

Rebecca E. Cash, Anjali J. Kaimal, Margaret E. Samuels-Kalow, Krislyn M. Boggs, Maeve F. Swanton & Carlos A. Camargo Jr (2023) Epidemiology of Emergency Medical Services-Attended out-of-Hospital Deliveries and Complications in the United States, Prehospital Emergency Care, DOI: 10.1080/10903127.2023.2283892