Progression of emergency obstetric care for unplanned out-of-hospital births: contributions from a 13-year prospective multicenter study in France

OBJECTIVE: To describe temporal trends in prehospital obstetric care for unplanned out-of-hospital births (UOHBs), assess adherence to clinical practice guidelines, and identify areas for improvement in training and health care organization. METHODS: We conducted a retrospective analysis using prospectively collected data from the French UOHB registry. A total of 3,473 births attended between October 2011 and June 2024 by 79 Emergency Medical Services centers were included. We analyzed temporal trends in maternal characteristics, modes of delivery, prehospital obstetric and neonatal care, and the main care-related time intervals. RESULTS: Significant increases were observed in the interval from the call to the dispatch center to the arrival of the medical team (P = .01) and in the time from delivery to placental expulsion (P < .01). The use of prophylactic oxytocin for active management of placental delivery increased (P = .01). By contrast, neonatal blood glucose measurement (P = .01) and routine nasopharyngeal suctioning (P < .01) decreased. In neonatal care, in situ temperature measurement decreased (P < .01). The use of caps, polyethylene bags, and blankets decreased, whereas skin-to-skin contact and incubator use during transport increased. The proportion of newborns who received no thermal protection measures increased (P = .045). CONCLUSIONS: Periodic dissemination of clinical practice guidelines has been associated with relevant changes in prehospital practice and greater adherence to recommendations. Nevertheless, important challenges remain, including increased response times, the need to consolidate the systematic use of prophylactic oxytocin, and effective prevention of neonatal hypothermia.