Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study

Abstract

ObjectivesCharacterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).DesignProspective observational study.SettingFive Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014.ParticipantsThis 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 measuresEmergency medical technician (EMT) interventions, method of delivery and death.ResultsThe 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))ConclusionsPregnant 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).

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

“…All patients who delivered prior to EMS arrival through 7 days after the dispatch call, were followed up by phone at 48 hours, 7 days and 42 days postpartum. 13 The 42-day follow-up period was used to capture maternal mortality as well as young infant outcomes.…”

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

“…Similar results were obtained by Strehlow at al. who found that nearly 80% of EMS interventions in India were to women in the third trimester reporting problems with pregnancy, also took place in rural areas [19]. A study by Cheung et al concerning the use of HEMS to transport patients with mild injuries, and a study by Goldstein et al analysing the EMS interventions in Canada, showed that interventions were also carried out more often in rural areas [20,21].…”

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

“… 21 24 26 35 37 A study from five states, showed that ‘108’ ambulances provide prehospital stabilising care to all pregnant women, and delivery and postdelivery care to those delivered at home or on the ambulance. 39 However, a study from Punjab found that about half of ‘108’ ambulances did not meet required standards for basic life support. 37 Monitoring of the quality of en route care and referral systems is integral for better outcomes and monitoring of any transport intervention.…”