{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T22:57:58Z","timestamp":1769554678387,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Higher Education of Poland","award":["SUBZ.L030.26.019"],"award-info":[{"award-number":["SUBZ.L030.26.019"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pre-hospital delivery is an unpredictable event posing significant challenges for Emergency Medical Services (EMS) teams. Despite advances in perinatal care, emergency deliveries outside the hospital environment remain associated with increased maternal and neonatal risks. This study aimed to identify predictors of out-of-hospital delivery in EMS-attended labor cases and determinants of neonatal condition immediately after delivery. Methods: We conducted a retrospective analysis of 5097 EMS records of laboring women in Poland from August 2021 to January 2022, of which 2927 were included in the final study sample. Multivariate logistic regression models with multiple imputation for missing data were used to identify predictors of pre-hospital delivery and adverse neonatal condition (Apgar \u2264 7) in EMS-managed childbirths. Results: Pre-hospital delivery was strongly associated with second-stage labor (OR \u2248 535; p &lt; 0.0001), ruptured membranes (OR \u2248 8.7; p &lt; 0.0001), and fewer previous pregnancies (OR = 0.86; p = 0.018), and showed a trend with higher maternal heart rate (OR = 1.015; p = 0.083). Neonatal status classified as Apgar \u2264 7 was significantly associated with preterm birth (p &lt; 0.0001), absence of fetal movements (OR \u2248 26.4; p = 0.025), and complications during pregnancy (p = 0.036). Complications during labor and lack of prenatal care were not significantly associated with increased risk of pre-hospital delivery in the model. Conclusions: Rupture of membranes, second-stage labor, and fewer previous pregnancies are significant predictors of pre-hospital delivery in EMS-managed cases. Absence of fetal movements and preterm gestation predict worse neonatal outcomes (Apgar \u2264 7). Early identification of these factors may enhance prehospital perinatal care and improve maternal and neonatal prognosis.<\/jats:p>","DOI":"10.3390\/jcm15030941","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:21:40Z","timestamp":1769505700000},"page":"941","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Every Minute Counts: Predicting Pre-Hospital Deliveries and Neonatal Risk in Emergency Medical Services Using Data-Driven Models"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6544-7225","authenticated-orcid":false,"given":"Joanna","family":"Wach","sequence":"first","affiliation":[{"name":"Division of Specialist Care in Midwifery and Gynaecology, Department of Midwifery, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7624-631X","authenticated-orcid":false,"given":"\u0141ukasz","family":"Lewandowski","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0740-7167","authenticated-orcid":false,"given":"Jakub","family":"Staniczek","sequence":"additional","affiliation":[{"name":"Chair and Clinical Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 40-211 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4245-5420","authenticated-orcid":false,"given":"Micha\u0142","family":"Czapla","sequence":"additional","affiliation":[{"name":"Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, 51-618 Wroclaw, Poland"},{"name":"Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, 26006 Logro\u00f1o, Spain"},{"name":"Nursing Care and Education Research Group (GRIECE), Department of Nursing, University of Valencia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/OGX.0000000000001224","article-title":"Postnatal Care: A Comparative Review of Guidelines","volume":"79","author":"Giouleka","year":"2024","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e010992","DOI":"10.1136\/bmjgh-2022-010992","article-title":"WHO Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience: Strengthening the Maternal and Newborn Care Continuum","volume":"8","author":"Wojcieszek","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sheikhi, R.A., and Heidari, M. (2024). The Challenges of Delivery in Pre-Hospital Emergency Medical Services Ambulances in Iran: A Qualitative Study. BMC Emerg. Med., 24.","DOI":"10.1186\/s12873-024-01073-z"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Committee on Obstetric Practice (2017). Committee Opinion No. 697: Planned Home Birth. Obstet. Gynecol., 129, e117\u2013e122.","DOI":"10.1097\/AOG.0000000000002024"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"(2013). FIGO Committee for the Ethical Aspects of Human Reproduction and Women\u2019s Health. Planned Home Birth. Int. J. Gynecol. Obstet., 120, 204\u2013205.","DOI":"10.1016\/j.ijgo.2012.10.001"},{"key":"ref_6","unstructured":"(2025, April 25). Approaches to Limit Intervention During Labor and Birth. Available online: https:\/\/www.acog.org\/clinical\/clinical-guidance\/committee-opinion\/articles\/2019\/02\/approaches-to-limit-intervention-during-labor-and-birth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2017.04.013","article-title":"Coding Update of the SMFM Definition of Low Risk for Cesarean Delivery from ICD-9-CM to ICD-10-CM","volume":"217","author":"Armstrong","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","unstructured":"Iwanowicz-Palus, G., and Kr\u00f3l, M. (2016). The Safety of Selected Birth Locations According to Women and Men. J. Public Health Nurs. Med. Rescue, 45\u201350."},{"key":"ref_9","unstructured":"Song\u00fcl Tomar G\u00fcneysu, O.D.G. (2025, May 03). Out-of-Hospital Delivery: A Case Report. Available online: https:\/\/caybdergi.com\/articles\/out-of-hospital-delivery-a-case-report\/doi\/cayd.galenos.2021.33254."},{"key":"ref_10","unstructured":"Beaird, D.T., Ladd, M., Jenkins, S.M., and Kahwaji, C.I. (2025). EMS Prehospital Deliveries. StatPearls, StatPearls Publishing."},{"key":"ref_11","unstructured":"Eisenbrey, D., Dunne, R.B., Fales, W., Torossian, K., and Swor, R. Describing Prehospital Deliveries in the State of Michigan. Cureus, 14, e26723."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1080\/10903127.2023.2283892","article-title":"Epidemiology of Emergency Medical Services-Attended out-of-Hospital Deliveries and Complications in the United States","volume":"28","author":"Cash","year":"2024","journal-title":"Prehospital Emerg. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1080\/07399332.2020.1830096","article-title":"Polish Maternity Services in Times of Crisis: In Search of Quality Care for Pregnant Women and Their Babies","volume":"41","author":"Doroszewska","year":"2020","journal-title":"Health Care Women Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1046\/j.0001-6349.2001.00420.x","article-title":"Accidental Out-of-Hospital Deliveries: An Obstetric and Neonatal Case Control Study","volume":"81","author":"Rodie","year":"2002","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3109\/01443615.2011.605484","article-title":"Born before Arrival Births: Impact of a Changing Obstetric Population","volume":"31","author":"Unterscheider","year":"2011","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1136\/emermed-2012-202309","article-title":"Involvement of Emergency Medical Services at Unplanned Births before Arrival to Hospital: A Structured Review","volume":"31","author":"McLelland","year":"2014","journal-title":"Emerg. Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"204","DOI":"10.12968\/bjom.2006.14.4.20786","article-title":"Birth before Arrival at Delivery Suite: Associations and Consequences","volume":"14","author":"Loughney","year":"2006","journal-title":"Br. J. Midwifery"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.29045\/14784726.2019.12.4.3.43","article-title":"Babies Born in the Pre-Hospital Setting Attended by Ambulance Clinicians in the North East of England","volume":"4","author":"McClelland","year":"2019","journal-title":"Br. Paramed. J."},{"key":"ref_19","first-page":"1115","article-title":"Emergency Medical Technicians\u2019 Experiences of the Challenges of Prehospital Care Delivery During the COVID-19 Pandemic: A Qualitative Study","volume":"31","author":"Imanipour","year":"2021","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Str\u00f3zik, M., Wiciak, H., Szarpak, L., Wroblewski, P., and Smereka, J. (2023). EMS Interventions during Planned Out-of-Hospital Births with a Midwife: A Retrospective Analysis over Four Years in the Polish Population. J. Clin. Med., 12.","DOI":"10.3390\/jcm12247719"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Flanagan, B., Lord, B., and Barnes, M. (2017). Is Unplanned Out-of-Hospital Birth Managed by Paramedics \u2018Infrequent\u2019, \u2018Normal\u2019 and \u2018Uncomplicated\u2019?. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1617-9"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"McLelland, G., McKenna, L., Morgans, A., and Smith, K. (2018). Epidemiology of Unplanned Out-of-Hospital Births Attended by Paramedics. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-017-1638-4"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gutvirtz, G., Wainstock, T., Landau, D., and Sheiner, E. (2020). Unplanned Out-of-Hospital Birth\u2014Short and Long-Term Consequences for the Offspring. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020339"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3390\/ecm1010003","article-title":"Addressing Challenges in EMS Department Operations: A Comprehensive Analysis of Key Issues and Solution","volume":"1","author":"Basnawi","year":"2023","journal-title":"Emerg. Care Med."},{"key":"ref_25","first-page":"1731","article-title":"Emergency Medical Team Interventions in Poland during Out-of-Hospital Deliveries: A Retrospective Analysis","volume":"34","author":"Wiciak","year":"2025","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"146","DOI":"10.5603\/GP.a2022.0046","article-title":"Use of the Expanded Apgar Score for the Assessment of Intraventricular and Intraparenchymal Haemorrhage Risk in Neonates","volume":"94","author":"Goralska","year":"2023","journal-title":"Ginekol. Pol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13049-019-0600-z","article-title":"Unplanned Out-of-Hospital Birth and Risk Factors of Adverse Perinatal Outcome: Findings from a Prospective Cohort","volume":"27","author":"Javaudin","year":"2019","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Rzo\u0144ca, E., Bie\u0144, A., Wejnarski, A., Gotlib, J., B\u0105czek, G., Ga\u0142\u0105zkowski, R., and Rzo\u0144ca, P. (2021). Suspected Labour as a Reason for Emergency Medical Services Team Interventions in Poland\u2014A Retrospective Analysis. Healthcare, 10.","DOI":"10.3390\/healthcare10010049"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cash, R.E., Swor, R.A., Samuels-Kalow, M., Eisenbrey, D., Kaimal, A.J., and Camargo, C.A. (2021). Frequency and Severity of Prehospital Obstetric Events Encountered by Emergency Medical Services in the United States. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04129-1"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Combier, E., Roussot, A., Chabernaud, J.-L., Cottenet, J., Rozenberg, P., and Quantin, C. (2020). Out-of-Maternity Deliveries in France: A Nationwide Population-Based Study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228785"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1038\/s41372-021-00935-9","article-title":"Maternal Transport: An Opportunity to Improve the System of Risk-Appropriate Care","volume":"41","author":"DeSisto","year":"2021","journal-title":"J. Perinatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1620\/tjem.250.25","article-title":"A Nationwide Survey of Obstetric Care Status on Japan\u2019s Islands, with Special Reference to Maternal Transport to the Mainland","volume":"250","author":"Sumikawa","year":"2020","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_33","first-page":"e933029-1\u2013e933029-7","article-title":"Polish Medical Air Rescue Interventions Concerning Pregnant Women in Poland: A 10-Year Retrospective Analysis","volume":"27","author":"Wejnarski","year":"2021","journal-title":"Med. Sci. Monit."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e019937","DOI":"10.1136\/bmjopen-2017-019937","article-title":"Reducing Early Infant Mortality in India: Results of a Prospective Cohort of Pregnant Women Using Emergency Medical Services","volume":"8","author":"Bills","year":"2018","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Khamehchian, M., Adib-Hajbaghery, M., HeydariKhayat, N., Rezaei, M., and Sabery, M. (2020). Primiparous Women\u2019s Experiences of Normal Vaginal Delivery in Iran: A Qualitative Study. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-02954-4"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"147","DOI":"10.5334\/aogh.2934","article-title":"Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review","volume":"86","author":"Alaofe","year":"2020","journal-title":"Ann. Glob. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1080\/10903127.2021.1988775","article-title":"A One-Year Cross Sectional Analysis of Emergency Medical Services Utilization and Its Association with Hypertension in Pregnancy","volume":"26","author":"Hutchcraft","year":"2022","journal-title":"Prehosp. Emerg. Care"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/941\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T09:36:47Z","timestamp":1769506607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15030941"],"URL":"https:\/\/doi.org\/10.3390\/jcm15030941","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}