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：明确经急救医疗服务（Emergency Medical Services，EMS）转运的产科患者的人口学特征、诊疗管理及结局。 研究设计：前瞻性观察性研究。 研究场景：印度5个邦，该地区依托一家集中式急救医疗服务机构，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方法，纳入1684名妊娠晚期孕妇，她们因与妊娠相关的诉求呼叫免费救护车转运。若急救医疗服务调度员将呼叫归类为"妊娠"、"分娩"、"流产"或"分娩阵痛"，则判定该呼叫为"妊娠相关"。本研究排除跨机构转运者、救护车到达时患者已不在场者以及拒绝接受救治者。 主要结局指标：急诊医疗技术员（Emergency Medical Technician，EMT）的干预措施、分娩方式及患者死亡情况。 研究结果：纳入受试者的中位年龄为23岁（四分位距IQR 21~25）。受试者主要来自农村/部落地区（1550/1684，92.0%）及经济欠发达阶层（1177/1684，69.9%）。与城市孕产妇相比，农村/部落地区孕产妇从首次呼叫到抵达医院的时间更长：分别为66分钟（IQR 51~84）与56分钟（IQR 42~73），p<0.0001。 急诊医疗技术员共协助44名孕产妇分娩，其中33例（75%）完成了胎盘娩出，29例（87.9%）实施了经腹子宫按摩，未使用催产素（0%）。 本研究共记录1411例分娩事件。其中多数孕产妇在医院分娩（1212/1411，85.9%），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名孕产妇死亡，均发生在入院后48小时内。剖宫产（Cesarean Section）率为8.2%（116/1411）。 多变量回归分析显示，相较于转运至政府基层卫生中心的孕产妇，转运至私立医院的孕产妇剖宫产分娩的可能性更低（优势比0.14，95%置信区间0.05~0.43）。 研究结论：印度弱势人群中的孕产妇会借助免费急救医疗服务应对即将到来的分娩，这使得急救医疗服务成为医疗保健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着重强化并拓展急救医疗服务，将其作为急诊产科与新生儿护理（Emergency Obstetric and Neonatal Care，EmONC）的组成部分。