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.

研究目的：阐明接受急诊医疗服务（Emergency Medical Services，EMS）转运的产科患者的人口统计学特征、诊疗管理情况与临床结局。
研究设计：前瞻性观察性研究。
研究场景：印度5个邦，当地设有统一的急诊医疗服务机构，该机构于2014年共转运孕产妇310万人次。
研究对象：本研究采用便利抽样法，纳入1684名妊娠晚期孕妇，她们因“妊娠相关主诉”呼叫免费救护车转运。若急诊医疗服务调度员将呼叫分类为“妊娠”“分娩”“流产”或“临产阵痛”时，该呼叫即被认定为“妊娠相关”。机构间转运、救护车抵达时患者已不在场、以及拒绝诊疗的患者被排除。
主要结局指标：急诊医疗技师（Emergency Medical Technician，EMT）的干预措施、分娩方式与死亡情况。
研究结果：纳入患者的中位年龄为23岁（四分位间距21~25岁）。受试者主要来自农村/部落地区（1550/1684，92.0%），且多处于较低经济阶层（1177/1684，69.9%）。与城市患者相比，农村/部落地区患者从首次呼叫至抵达医院的时间更长：农村/部落地区患者为66分钟（四分位间距51~84分钟），城市患者为56分钟（四分位间距42~73分钟），差异具有统计学意义（p<0.0001）。急诊医疗技师协助44名孕妇完成分娩，其中33例（75.0%）协助娩出胎盘，29例（87.9%）实施经腹子宫按摩，未使用催产素（0%）。本研究共记录1411例分娩。大多数孕妇在医院分娩（1212/1411，85.9%），但126/1411（8.9%）在出院后于家中分娩。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名孕妇死亡，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，与被转运至政府基层卫生中心的孕妇相比，转运至私立医院的孕妇剖宫产概率更低（比值比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即将发生的分娩，该服务已成为印度医疗体系不可或缺的组成部分。未来的研究与卫生系统规划应聚焦于强化并拓展急诊医疗服务，将其作为急诊产科与新生儿急救（Emergency Obstetric and Neonatal Care，EmONC）的组成部分。