Accidental out-of-hospital deliveries: a case-control study

Abstract

Aim: To determine risk factors for accidental out-of-hospital deliveries (OHDs), which represent 0.5% of live births in France and are associated with poor neonatal outcomes.

Methods: This retrospective case-control study assessed accidental OHDs that occurred in the Finistère District (Brittany, France) between January 2007 and December 2009. For each OHD case, two controls were randomly selected. Outcome measures included maternal demographics, obstetric characteristics and neonatal outcomes.

Results: During the study period, accidental OHDs accounted for 0.42% of all births; 76 accidental OHDs were included in the analysis. Multivariate analysis found four independent risk factors for accidental OHD: multiparity [OR: 8.84 (3.22-24.29)], unemployment [OR: 4.99 (1.85-13.47)], lack of or poor antenatal care [OR: 9.00 (2.41-33.72)] and a travel time >45 min from home to the delivery unit [OR: 6.18 (1.33-28.65) versus < 15 min]. Significantly more newborns from the OHD group required admission to the neonatal unit (p = 0.04), but accidental OHD was not significantly associated with prematurity or low birth weight.

Conclusion: Four risk factors for accidental OHD were identified. Setting up an anonymous registry of OHD cases could improve our knowledge and screening of women at risk.

Keywords: Accidental out-of-hospital delivery; Home-to-delivery unit distance; Neonatal outcome; Risk factor.