Effect of the score predicting imminent delivery on the management of unexpected out-of-hospital obstetrical deliveries: a cluster randomized clinical trial
Résumé
Background and importance Early identification of imminent deliveries is crucial for guiding the decision to dispatch emergency medical team to the prehospital setting. Objective To study whether the use of the score predicting imminent delivery (SPID) at the emergency call center reduces the risk of prehospital delivery occurring without the presence of a physician-staffed mobile ICU team. Design, setting, and participants Prospective multicenter cluster randomized controlled trial in 19 call centers in France. Calls from pregnant woman in labor with at least 33 weeks of amenorrhea were eligible. The emergency call center responses included medical advice, transport to the hospital by personal means or ambulance, or dispatch of the mobile ICU team. Intervention In the intervention group, the use of the SPID was mandatory to guide decision-making. Outcomes measures and analysis The primary outcome was the rate of prehospital deliveries occurring without the initial dispatch of a mobile ICU team. The secondary endpoints included the prehospital deliveries rate without the presence of a mobile ICU team on site, call duration, satisfaction score, and maternal and neonatal mortality. Main results A total of 7782 pregnant women were included in the intention-to-treat analysis (3773 control and 4009 intervention), including 523 (7.0%) prehospital deliveries (6.3% intervention and 7.6% control) and a 22.3% rate of mobile ICU dispatch decision (20.8% intervention group and 23.8% control). Prehospital delivery without initial dispatch of a mobile ICU was less frequent in the intervention group compared to control: 0.95 vs. 2.01% [odds ratio (OR) 0.46; 95% confidence interval (CI), 0.31–0.70]. There was also a lower rate of prehospital delivery without the presence of a mobile ICU team on site in the intervention group: 1.92 vs. 3.34% (OR = 0.58; 95% CI, 0.42–0.82). There was no significant difference in the other secondary endpoints. Conclusion In this multicenter randomized controlled trial, the systematic use of the SPID was associated with a reduction of prehospital deliveries occurring without the presence of a mobile ICU team.