Unplanned out‐of‐hospital deliveries: Insights from 3473 births of a 13‐year prospective cohort study in France

Introduction Although poorly researched, unplanned out‐of‐hospital deliveries are considered to carry a high risk of maternal and neonatal complications, with the primary suspected risk factor being the home‐to‐hospital travel time. The objective of this study was to describe the characteristics of unplanned out‐of‐hospital deliveries and to identify factors associated with maternal and neonatal complications. Material and Methods Data were collected from the French unplanned out‐of‐hospital deliveries registry (79 of 402 mobile intensive care units). Analysis included 3473 deliveries between October 2011 and June 2024. Results Mean women maternal age was 32.0 ± 5.4 years (range 15–49). Median parity was 2.0 (IQR 2.0–3.0). Gestational age was 39.1 ± 2.3 weeks. Most pregnancies were low‐risk (84%). Mean home‐to‐hospital travel time was 20.7 ± 13.6 min (range 0–200), with more than 45 min for only 3% of women (110/3221) and over 1 h for 1% (23/3221). Maternal complications accounted in 8.4% of women (290/3472), placental hemorrhage in 4.5% (156/3471) and maternal death in 0.1% (2/3471). Perinatal complications occurred in 4.4% (149/3393) of all deliveries, with neonatal deaths accounting for 1.1% (38/3456). Among unplanned out‐of‐hospital deliveries, factors associated with maternal and/or neonatal complications included birth at 32 + 0–33 + 6 weeks of gestation (adjusted OR 2.86, 95% CI 1.69 to 4.83; p < 0.0001), birth before 32 + 0 weeks of gestation (adjusted OR 25.21, 95% CI 12.13 to 52.40; p < 0.0001), and neonatal hypothermia upon hospital admission (adjusted OR 1.74, 95% CI 1.10 to 2.76; p = 0.019). Hypothermia affected 63% of newborns (1256/2002). Unplanned out‐of‐hospital deliveries prior to mobile intensive care unit arrival were significantly associated with neonatal hypothermia on‐site (adjusted OR 2.02, 95% CI 1.57 to 2.61; p < 0.0001) and at hospital admission (adjusted OR 1.56, 95% CI 1.21 to 2.00; p = 0.0005). Conclusions Severe outcomes of unplanned out‐of‐hospital deliveries were uncommon but did occur. Complications were associated with prematurity and hypothermia, but not with home‐to‐hospital travel time. These findings highlight the importance of universal prehospital preparedness, with particular attention to early prevention of neonatal hypothermia and initial hemorrhage management.