Data from: Characteristics and outcomes of women utilizing emergency medical services for third-trimester pregnancy-related complaints in India: a prospective observational study

Objectives: Characterize the demographics, management, and outcomes of obstetric patients transported by emergency medical services (EMS). Design: Prospective observational study. Setting: Five Indian states utilizing a centralized EMS agency that transported 3.1 million pregnant women in 2014. Participants: This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a “pregnancy-related” complaint for free-of-charge ambulance transport. Calls were deemed “pregnancy-related” if categorized by EMS dispatchers as “pregnancy”, “childbirth”, “miscarriage”, or “labor pains”. Interfacility transfers, patients absent upon ambulance arrival, and patients refusing care were excluded. Main outcome measures: Emergency medical technician (EMT) interventions, method of delivery, and death. Results: The median age enrolled was 23 years (IQR 21-25). Women were primarily from rural/tribal areas (1550/1684 (92.0%)) and lower economic strata (1177/1684 (69.9%)). Time from initial call to hospital arrival was longer for rural/tribal compared to urban patients (66 min (IQR 51-84) vs 56 min (IQR 42-73), respectively, p<0.0001). EMTs assisted delivery in 44 women, delivering the placenta in 33/44 (75%), performing transabdominal uterine massage in 29/33 (87.9%), and administering oxytocin in none (0%). There were 1411 recorded deliveries. Most women delivered at a hospital (1212/1411 (85.9%)), however 126/1411 (8.9%) delivered at home following hospital discharge. Follow-up rates at 48 hours, 7 days, and 42 days were 95.0%, 94.4%, and 94.1%, respectively. Four women died, all within 48 hours. The cesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centers were less likely to deliver by cesarean section (odds ratio 0.14 (0.05 to 0.43)). Conclusions: Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the health care system. Future research and health system planning should focus on strengthening and expanding EMS as a component of EmONC.

研究目标：描述通过急诊医疗服务（Emergency Medical Services，EMS）转运的产科患者的人口学特征、诊疗管理及预后情况。研究设计：前瞻性观察性研究。研究地点：覆盖印度5个邦，当地依托统一的急诊医疗服务机构，2014年该机构累计转运孕产妇310万人次。研究对象：本研究采用便利抽样方法，纳入1684名因“妊娠相关诉求”呼叫免费救护车转运的妊娠晚期女性。EMS调度员将归类为“妊娠”“分娩”“流产”或“临产阵痛”的呼叫判定为妊娠相关诉求。本研究排除跨机构转运患者、救护车到达时患者已不在场及拒绝接受诊疗的病例。主要结局指标：急诊医疗技术员（Emergency Medical Technician，EMT）的干预措施、分娩方式及死亡情况。研究结果：纳入研究的女性中位年龄为23岁（四分位间距21~25岁）。受试者主要来自农村/部落地区（1550/1684，占92.0%）及低收入阶层（1177/1684，占69.9%）。农村/部落地区患者从首次呼叫到抵达医院的时长显著长于城市患者（66分钟，四分位间距51~84分钟 vs 56分钟，四分位间距42~73分钟，p<0.0001）。急诊医疗技术员协助44名女性完成分娩，其中33例（75.0%）协助娩出胎盘，29例（87.9%，针对33例胎盘娩出者）实施经腹子宫按摩，未给予催产素（0%）。本研究共记录1411例分娩事件。绝大多数女性在医院完成分娩（1212/1411，占85.9%），但另有126例（8.9%）在出院后于家中分娩。受试者在48小时、7天及42天的随访率分别为95.0%、94.4%及94.1%。共有4名女性死亡，均发生在48小时内。剖宫产率为8.2%（116/1411）。多因素回归分析显示，与转诊至政府基层卫生中心的女性相比，转诊至私立医院的女性剖宫产概率更低（优势比0.14，95%置信区间0.05~0.43）。研究结论：来自印度弱势人群的孕产妇会使用免费急诊医疗服务应对临产分娩，这使得EMS成为印度医疗体系中不可或缺的组成部分。未来的研究与医疗体系规划应聚焦于强化并拓展急诊医疗服务，将其作为产科急诊医疗服务（Emergency Obstetric and Neonatal Care，EmONC）的核心组成部分。