Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study
Objectives Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).Design Prospective observational study.Setting Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014.Participants Th...
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BMJ Publishing Group
2016-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/6/7/e011459.full |
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| author | Jennifer A Newberry Corey B Bills Elizabeth A Pirrotta Matthew C Strehlow G V Ramana Rao Hyeyoun (Elise) Min Ann E Evensen Lawrence Leeman S V Mahadevan |
| author_facet | Jennifer A Newberry Corey B Bills Elizabeth A Pirrotta Matthew C Strehlow G V Ramana Rao Hyeyoun (Elise) Min Ann E Evensen Lawrence Leeman S V Mahadevan |
| author_sort | Jennifer A Newberry |
| collection | DOAJ |
| description | Objectives Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).Design Prospective observational study.Setting Five Indian states using a centralised 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’ problem for free-of-charge ambulance transport. Calls were deemed ‘pregnancy related’ if categorised by EMS dispatchers as ‘pregnancy’, ‘childbirth’, ‘miscarriage’ or ‘labour pains’. Interfacility transfers, patients absent on 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 or 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 with 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 caesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centres were less likely to deliver by caesarean section (OR 0.14 (0.05–0.43))Conclusions Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the healthcare system. Future research and health system planning should focus on strengthening and expanding EMS as a component of emergency obstetric and newborn care (EmONC). |
| format | Article |
| id | doaj-art-7e8ca127eea9441aa02649c53adc4fd2 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2016-07-01 |
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| series | BMJ Open |
| spelling | doaj-art-7e8ca127eea9441aa02649c53adc4fd22025-02-11T17:00:11ZengBMJ Publishing GroupBMJ Open2044-60552016-07-016710.1136/bmjopen-2016-011459Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational studyJennifer A Newberry0Corey B Bills1Elizabeth A Pirrotta2Matthew C Strehlow3G V Ramana Rao4Hyeyoun (Elise) Min5Ann E Evensen6Lawrence Leeman7S V Mahadevan81Department of Emergency Medicine, Stanford University, Stanford, California, USA2Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA1 Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USAEmergency Medicine, Stanford University, Stanford, California, USA6 Emergency Medicine Learning Center and Research, GVK Emergency Management and Research Institute, Secunderabad, Telangana, India3Department of Surgery, Division of Plastic Surgery, University of Washington/Harborview Medical Center, Seattle, Washington, USA4Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Verona, Wisconsin, USA5Departments Family and Community Medicine and Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico, USA1Department of Emergency Medicine, Stanford University, Stanford, California, USAObjectives Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).Design Prospective observational study.Setting Five Indian states using a centralised 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’ problem for free-of-charge ambulance transport. Calls were deemed ‘pregnancy related’ if categorised by EMS dispatchers as ‘pregnancy’, ‘childbirth’, ‘miscarriage’ or ‘labour pains’. Interfacility transfers, patients absent on 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 or 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 with 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 caesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centres were less likely to deliver by caesarean section (OR 0.14 (0.05–0.43))Conclusions Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the healthcare system. Future research and health system planning should focus on strengthening and expanding EMS as a component of emergency obstetric and newborn care (EmONC).https://bmjopen.bmj.com/content/6/7/e011459.full |
| spellingShingle | Jennifer A Newberry Corey B Bills Elizabeth A Pirrotta Matthew C Strehlow G V Ramana Rao Hyeyoun (Elise) Min Ann E Evensen Lawrence Leeman S V Mahadevan Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study BMJ Open |
| title | Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study |
| title_full | Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study |
| title_fullStr | Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study |
| title_full_unstemmed | Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study |
| title_short | Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study |
| title_sort | characteristics and outcomes of women using emergency medical services for third trimester pregnancy related problems in india a prospective observational study |
| url | https://bmjopen.bmj.com/content/6/7/e011459.full |
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