487 - Out-of-Hospital and Unplanned Deliveries: Maternal and Infant Factors to Better Understand this Public Health Problem

Poster Number: 487
Publication Number: 487.31

Jessica Yom, University of Southern California/Keck School of Medicine of USC, Los Angeles, CA, United States; Shannon Liu, The Permanente Medical Group, San Leandro, CA, United States; Lorayne Barton, LAC+USC Medical Center, Los Angeles, CA, United States; Rangasamy Ramanathan, Keck School of Medicine of USC, Los Angeles, CA, United States; Manoj Biniwale, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States

Background: Out-of-hospital births have been increasing since the early 2000s. From 2004 to 2017, the number of out-of-hospital births in the United States (US) increased by 75%. Currently, there is limited published data to aid in understanding this public health issue.

Objective: Our aim was to evaluate the maternal and infant risk factors and characteristics of out-of-hospital and threatened deliveries presenting to the Emergency Department (ED) of a safety net hospital that is a Level 1 Trauma Center in a large metropolitan city in the US.

Design/Methods: Retrospective chart review of electronic medical records from June 2015 to August 2022 of infants and their mothers arriving to the ED by ambulance who delivered prior to hospital arrival or delivered imminently in the hospital.

Results: Charts for 148 mother-baby dyads were reviewed. Mean maternal age was 29 years with mean gravida and para status prior to delivery being 3 and 1 respectively. Active substance use was detected in 49% of mothers with the most common being amphetamines (35%) on urine toxicology screen. A third of mothers (34%) received no prenatal care. Additionally, the two most common comorbid maternal conditions were psychiatric disorders (18%) and hypertension (18%). 62% of infants (n = 92) were born prior to hospital arrival. Of those infants born prior to hospital arrival, 64% required neonatal intensive care unit (NICU) admission when compared to 41% of infants born after hospital arrival (p = 0.01). The median birthweight was 2910 grams and gestational age was 38 weeks. Almost half (42%) of infants required advanced resuscitation which correlated with the risk factor of maternal drug use (p = 0.045). The average first temperature of all infants was 35.7°C. A majority (70%) of infants born prior to hospital arrival were hypothermic (p ≤ 0.01) and hypothermic infants required more advanced resuscitation than normothermic infants (p = 0.01). Other neonatal morbidities included hypoglycemia, respiratory distress, sepsis, hypoxic ischemic encephalopathy and death.

Conclusion(s): Out-of-hospital and impending deliveries presenting to the ED were associated with high rates of neonatal advanced resuscitation and led to increased morbidity in these infants including hypothermia and respiratory distress. Need for advanced resuscitation was more common in hypothermic infants. These imminent deliveries were associated with mothers who had psychiatric disorders, hypertension, lacked prenatal care, and used illicit substances.