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CAA Congress 2024: Kevin Keane - A Structured Review

Kevin is a Paramedic with St John Ambulance WA. Previously Kevin was a research Academic with Curtin University for 9 years. His formal research training was in biochemistry, but he later branched out into clinical data analysis in collaboration with an IVF facility. This initiated his current interest in obstetrics. Introduction: Paramedics infrequently attend out-of-hospital (OOH) deliveries, but these can be high-risk clinical events. Postpartum haemorrhage (PPH) is the most common pregnancy risk-factor for maternal mortality and morbidity. This structured review aimed to determine OOH delivery and PPH frequency, and to summarise typical paramedic OOH PPH clinical management. Method: Five databases were searched for peer-reviewed articles using variations of OOH/prehospital and PPH search terms. Inclusion criteria were OOH deliveries attended by paramedics, reporting OOH delivery epidemiology or OOH clinical PPH management. Articles were assessed by two independent reviewers using PRISMA, and relevance determined with CASP. Results: Initially 145 publications contained variations of OOH/PPH search terms. After duplicate removal, 70 articles were screened by title/abstract and 25 full-text articles were examined. Seventeen irrelevant articles were eliminated, but 7 additional publications were included from reference lists to leave 15 for final analysis in total. All included publications reported OOH PPH frequency and represented 4 countries and 9 ambulance regions. OOH deliveries accounted for 0.003-0.13% of ambulance callouts, and OOH PPH incidence ranged from 2.1-18% of OOH deliveries attended by paramedics. Nine articles reported various aspects of OOH PPH clinical management, with the most common interventions including cannulation/fluid therapy (N=5), uterotonic administration (N=4), uterine fundal massage (N=4), oxygen (N=3) and pain relief (N=2). Conclusion: Peer-reviewed articles investigating paramedic-attended OOH delivery and PPH epidemiology are limited. Treatment and caseload are dependent on country and service. This analysis confirms that while OOH births are rare for paramedics, they have a significant risk for serious complications.