Epidemiology of Birth Before hospital Arrival in Himachal Pradesh, India

Background: Obstetric-related mortality is high in India. Due to delays in accessing care and barriers to transport, many births are attended by emergency medical technicians (EMTs). Understanding the trends in use of emergency services may help government decision-makers improve services and safety for Indian mothers and newborns.

Methods: 807,548 calls received between December 2010 and March 2017 by emergency call centers in the Indian State of Himachal Pradesh were reviewed. The emergency call location, transport type (primary [PT] or inter-facility [IFT]) and outcomes (Birth Before Arrival [BBA] or transport undelivered) were identified. Median response and transport times were calculated. Chi-square tests of independence were performed.A subset of BBAs was reviewed to determine complications encountered and intervals from emergency call to BBA.

Results: Of 807,548 total emergency calls there were 166,523 pregnancy-related calls (20.6%). 159,119 pregnant women (95.6%) were transported undelivered and 7,404 (4.4%) experienced a BBA.64.5% of BBAs occurred in the ambulance and 35.5% at the scene. Over time, IFT increased from 9.4% to 21.9% of pregnancy calls (p<0.01), and BBAs increased from 3.9% to 4.5% (p<0.01). The most sparsely-populated Districts had the highest rates of IFTs and BBAs. Complications were seen in 41% of the 387 women experiencing BBAsand 6.4% of their neonates.

Conclusions: Twenty percent of calls for EMT services in the Indian State of Himachal Pradesh are pregnancy-related. The rates of inter-facility transport and birth before arrivalhave increased. Opportunities for safe and expeditious emergency transport of pregnant patients should be maximized to improve safe motherhood in India.

Keywords: Maternal mortality; Emergency management systems; Safe delivery; Simulation; Health care delivery; Birth before arrival.