Data from: Reducing early infant mortality in India: results of a prospective cohort of pregnant women utilizing emergency medical services

Objectives: To describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India. Design: Prospective observational study. Setting: Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014. Participants: Over 6 weeks in 2014, this study followed a convenience sample of 1,431 neonates born to women utilizing a public-private ambulance service for a ‘pregnancy related’ problem. Initial calls were deemed ‘pregnancy related’ if categorised by EMS dispatchers as ‘pregnancy’, ‘childbirth’, ‘miscarriage’ or ‘labour pains’. Interfacility transfers, patients absent on ambulance arrival, refusal of care, and neonates born to women beyond 7 days of using the service were excluded. Main outcome measures: Death at 2, 7 and 42 days after delivery. Results: Among 1,684 women, 1,411 gave birth to 1,431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR: 21-25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42-days follow-up were 41, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth [OR: 2.89, 95% CI: 1.67-5.00], twin deliveries (OR: 2.80, 95% CI: 1.10-7.15), and cesarean section (2.21, 95% CI: 1.15-4.23) were the strongest predictors of mortality. Conclusions: The perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data has the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare, and increase facility-based care through service of marginalized populations.

研究目的：描述印度五个邦范围内，经公共救护车转运至医院的孕产妇所诞下的、于转运后7天内出生的新生儿的人口统计学特征与临床结局。
研究设计：前瞻性观察性研究。
研究开展场景：覆盖印度五个邦，依托一家统一运营的急诊医疗服务（Emergency Medical Services, EMS）机构开展，该机构在2014年累计转运孕产妇310万人次。
研究对象：2014年，本研究在6周余的周期内，对便利抽样选取的1431名新生儿进行随访，这些新生儿的母亲因妊娠相关问题使用了公私合营救护车服务。若急诊医疗服务调度员将初始呼救归类为“妊娠”“分娩”“流产”或“临产阵痛”，则该呼救被认定为“妊娠相关”。本研究排除机构间转运病例、救护车抵达时患者不在场、拒绝接受救治的病例，以及孕产妇使用救护车服务后7天以上才出生的新生儿。
主要结局指标：分娩后2天、7天及42天的新生儿死亡率。
结果：在纳入的1684名孕产妇中，1411人在首次救护车转运后7天内分娩，共计诞下1431名活产新生儿。孕产妇分娩时的中位年龄为23岁（四分位数间距Interquartile Range, IQR：21~25岁）。绝大多数孕产妇来自农村/部落地区（92.5%），社会地位较低（79.9%）且经济状况拮据（69.9%）。产后2天、7天及42天的随访率分别为99.8%、99.3%及94.1%。随访至产后2天、7天及42天时的累积死亡率分别为每1000名活产儿41例、53例及62例。围产期死亡率（Perinatal Mortality Rate, PMR）为每1000名活产儿53例。早产[优势比（Odds Ratio, OR）=2.89，95%置信区间（Confidence Interval, CI）：1.67~5.00]、双胎分娩（OR=2.80，95%CI：1.10~7.15）以及剖宫产（OR=2.21，95%CI：1.15~4.23）是新生儿死亡的最强预测因素。
结论：本队列中罹患妊娠高危病症的孕产妇群体，其相关围产期死亡率几乎是印度全国最新围产期死亡率（每1000名活产儿28例）的两倍。急诊医疗服务数据可为围产期死亡率提供更为精准可靠的估算值，有助于减少孕产妇及时获取医疗服务的公平性差距，并通过为边缘弱势群体提供服务，提升医疗机构分娩照料的覆盖范围。