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Tytuł:
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Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services.
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Autorzy:
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Bills CB; Department of Emergency Medicine, University of California, San Francisco, California, USA.
Newberry JA; Department of Emergency Medicine, Stanford University, Stanford, California, USA.
Darmstadt G; Department of Pediatrics, Stanford University, Stanford, California, USA.
Pirrotta EA; Department of Emergency Medicine, Stanford University, Stanford, California, USA.
Rao GVR; GVK Emergency Management and Research Institute, Secunderabad, Telangana, India.
Mahadevan SV; Department of Emergency Medicine, Stanford University, Stanford, California, USA.
Strehlow MC; Department of Emergency Medicine, Stanford University, Stanford, California, USA.
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Źródło:
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BMJ open [BMJ Open] 2018 Apr 13; Vol. 8 (4), pp. e019937. Date of Electronic Publication: 2018 Apr 13.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
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MeSH Terms:
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Emergency Medical Services*
Infant Mortality*
Prenatal Care*/standards
Adolescent ; Cesarean Section ; Female ; Humans ; India ; Infant ; Infant, Newborn ; Pregnancy ; Prospective Studies ; Young Adult
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References:
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Contributed Indexing:
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Keywords: Emergency Medical Services (ems); India; Maternal Medicine; Neonatal Mortality
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Entry Date(s):
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Date Created: 20180415 Date Completed: 20190307 Latest Revision: 20190307
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Update Code:
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20240104
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PubMed Central ID:
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PMC5905760
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DOI:
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10.1136/bmjopen-2017-019937
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PMID:
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29654018
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Objectives: To describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India.
Design: Prospective observational study.
Setting: Five Indian states using a centralised emergency medical services (EMS) agency that transported 3.1 million pregnant women in 2014.
Participants: Over 6 weeks in 2014, this study followed a convenience sample of 1431 neonates born to women using a public-private ambulance service for a 'pregnancy-related' problem. Initial calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival, refusal of care and neonates born to women beyond 7 days of using the service were excluded.
Main Outcome Measures: death at 2, 7 and 42 days after delivery.
Results: Among 1684 women, 1411 gave birth to 1431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR 21-25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42 days follow-up were 43, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth (OR 2.89, 95% CI 1.67 to 5.00), twin deliveries (OR 2.80, 95% CI 1.10 to 7.15) and caesarean section (OR 2.21, 95% CI 1.15 to 4.23) were the strongest predictors of mortality.
Conclusions: The perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data have the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare and increase facility-based care through service of marginalised populations.
Competing Interests: Competing interests: None declared.
(© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
