French cohort links prematurity and hypothermia to complications after out-of-hospital birth

A 13-year prospective French registry cohort included 3,473 unplanned out-of-hospital deliveries. Severe outcomes were uncommon, but complications were associated with prematurity and neonatal hypothermia, not with home-to-hospital travel time.

Maternal complications occurred in 8.4% of cases.
Prematurity was associated with increased complication odds.
Neonatal hypothermia affected 63% of newborns with available data.
Travel time was not associated with complications.

Researchers analyzed 3,473 unplanned out-of-hospital deliveries recorded from October 2011 to June 2024 in a French registry covering 79 mobile intensive care units. Most pregnancies were classified as low risk (84%); mean gestational age was 39.1 weeks, and mean home-to-hospital travel time was 20.7 minutes. The study examined maternal and perinatal complications and factors associated with these outcomes.

Maternal complications occurred in 8.4% of women, including placental hemorrhage in 4.5%; maternal death occurred in 0.1%. Perinatal complications were reported in 4.4% of deliveries, and neonatal death in 1.1%. Birth at 32–33 weeks was associated with higher odds of maternal and/or neonatal complications (adjusted OR 2.86), as was birth before 32 weeks (adjusted OR 25.21). Neonatal hypothermia was recorded in 63% of newborns with available data. Deliveries before mobile intensive care unit arrival were associated with hypothermia on site and at hospital admission.

The registry findings identify prematurity and hypothermia as markers associated with complications; travel time was not associated. The observational data do not establish causation, and the authors recommend prehospital preparedness, including early attention to newborn warming and initial hemorrhage management.

In practice

For teams responding to unplanned out-of-hospital births, this cohort supports prioritizing preparedness for premature delivery, newborn thermal protection, and initial hemorrhage management. Prematurity, especially birth before 32 weeks, was strongly associated with maternal and/or neonatal complications, while hypothermia was common and associated with delivery before mobile intensive care unit arrival. These are observational associations and do not prove that hypothermia causes complications or establish that a specific intervention improves outcomes; the findings do not support changing care based on travel time alone.

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Source

Acta Obstetricia et Gynecologica Scandinavica: Unplanned out‐of‐hospital deliveries: Insights from 3473 births of a 13‐year prospective cohort study in France ↗

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