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.