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854: Does unplanned out-of-hospital birth increase the risk for perinatal mortality ?

      Objective

      The unpredictable nature of childbirth infrequently results in unplanned out of hospital birth, in pre- hospital setting. We sought to determine maternal characteristics and evaluate perinatal outcome of unplanned out-of-hospital births compared to attended in-hospital deliveries.

      Study Design

      A population-based cohort analysis was performed including all registered singleton deliveries occurring between 1991-2014 at a single tertiary medical center. Maternal characteristics and pregnancy outcomes of unplanned out-of-hospital births were compared with those of women who delivered in the hospital. Multivariable generalized estimating equation (GEE) analysis was performed to control for confounders.

      Results

      During the study period, 243,682 singleton deliveries met the inclusion criteria. Of them, 1.5% (n=3,580) were unplanned out-of-hospital births. Most out-of-hospital births occurred in multiparous women (95.9% vs. 76.1%; P<0.001). About a quarter of these women had inadequate prenatal care (26.2%), compared to only 8.7% of women who delivered in-hospital (P<0.001). Women who delivered out-of-hospital were less likely to be diagnosed with diabetes (pre-gestational or gestational) or hypertensive disorder of pregnancy (chronic, gestational hypertension or pre-eclampsia) as compared with women who delivered in-hospital (2.4% vs. 5.0%, P<0.001 and 1.2% vs. 5.1%, P<0.001; respectively, Table 1). Preterm birth rates were higher for out-of-hospital births (9.1% vs. 6.8%; P<0.001) and those babies had higher rates of low birth weight (<2500 gr.) as compared with in-hospital birth (11.6% vs. 6.7%; P<0.001). Perinatal mortality rate was significantly higher for out-of-hospital births as compared with in- hospital births (15/1000 vs. 5/1000; P <0.001, Table 2). In the GEE model, while controlling for gestational age, diabetes, hypertensive disorders, smoking and ethnicity, out-of-hospital delivery was found to be an independent risk factor for perinatal mortality (adjusted OR=2.6, 95% CI 1.9-3.5, p<0.001).

      Conclusion

      Unplanned out-of-hospital delivery is an independent risk factor for perinatal mortality.
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