ABSTRACTS
Is EMS Failing to Recognize and Treat Significant Antepartum Hemorrhage?Author: Anita Swiman BS, CHSE, EMT-P | Training Captain | Durham County NC EMS Associate Authors:
Introduction Postpartum hemorrhage is widely recognized as a leading cause of maternal mortality and has prompted the development of prehospital protocols incorporating tranexamic acid and blood product administration. In contrast, antepartum hemorrhage remains underrepresented in emergency medical services (EMS) research. Objective Using national electronic health record data, this study aims to evaluate whether EMS systems are adequately managing antepartum hemorrhage. Methods We conducted a retrospective observational analysis utilizing the 2023 ESO Solutions Data Collaborative dataset. Descriptive statistics were calculated using SPSS 30. The inclusionary criteria included known pregnancy with non-traumatic vaginal bleeding who were transported by paramedic staffed ambulances. Results There were approximately 14 million EMS encounters in 2023. Among these, 94,462 (0.68%) encounters involved known pregnant patients, of whom 4,154 (4.4%) presented with nontraumatic antepartum hemorrhage. Among this group, 3,184 (76.65%) were transported by a paramedic staffed ambulance, and 785 (24.65%) presented with a shock index ≥0.9, indicating potential hemodynamic instability. The mean age of patients who were transported by a paramedic staffed ambulance was 28.2 years (SD±6.8), with 1,474 (46.29%) identifying as Caucasian, and a gestational age distribution of 1,130 (35.48%) at <12 weeks, 679 (21.33%) at 12-20 weeks, and 961(30.18%) > 20 weeks. Despite clinical indicators of hypovolemia, 1,677 (52.67%) patients received no documented prehospital intervention. Among those who received treatment, the mean volume of intravenous fluid administered was 243mL (SD±345mL). Tranexamic acid was administered to 14 patients (0.44%), while 9 patients (0.28%) received blood products and 2 patients (0.06%) received a combination of fluids, tranexamic acid, and blood products. Conclusion Within the limitations of our study design, this study provides an assessment of EMS responses to bleeding during pregnancy. The findings suggest an undertreatment of antepartum hemorrhage. Future research should focus on identifying the factors associated with undertreatment, addressing these deficiencies may improve maternal outcomes in obstetric emergencies that occur prior to delivery.
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