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Frequency and Factors Associated with Patient Safety Events During Prehospital Obstetric Emergencies

Rebecca E Cash1,2, Maeve F Swanton1, Melissa A Meeker1

  • 1Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.

Prehospital Emergency Care
|June 4, 2025
PubMed

Insights

Patient safety events (PSE) are frequent during out-of-hospital obstetric emergencies. Identifying high-risk patient groups can guide interventions to improve care during emergency medical services (EMS) treatment for delivery and postpartum hemorrhage (PPH).

Area of Science:

  • Emergency Medicine
  • Obstetrics
  • Patient Safety

Background:

  • Patient safety events (PSE) are well-documented in prehospital care for high-acuity and pediatric patients.
  • However, data on PSE during obstetric emergencies in the prehospital setting are limited.

Purpose of the Study:

  • To investigate the frequency and identify factors associated with PSEs during out-of-hospital delivery and postpartum hemorrhage (PPH).
  • To examine PSEs treated by emergency medical services (EMS) clinicians in the United States.

Main Methods:

  • A cross-sectional analysis of advanced life support EMS 9-1-1 activations for patients aged 12-50 years with out-of-hospital delivery or PPH (2018-2019 National EMS Information System).
  • PSEs were defined as adverse events, suboptimal actions, or errors related to EMS interventions.
  • Modified Poisson mixed-effects regression models were used to calculate prevalence ratios and marginal adjusted prevalence.

Main Results:

  • A high rate of PSEs was observed: 27% for out-of-hospital delivery (n=7283) and 69% for PPH (n=1273).
  • Factors associated with lower PSE prevalence in delivery included multiples, preterm labor, shorter scene times, and higher community diversity.
  • Factors associated with higher PSE prevalence in delivery included obstetric-capable hospital presence and delivery complications. For PPH, complications, multiples, longer scene time, community vulnerability, and hospital presence increased PSE risk.

Conclusions:

  • Significant rates of PSEs occur during prehospital obstetric emergencies, including out-of-hospital delivery and PPH.
  • Specific patient subgroups face higher risks, necessitating targeted educational and system-level interventions.
  • Understanding these risk factors is crucial for developing strategies to mitigate PSEs in this vulnerable population.
Abstract

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