Introduction L’Accouchement Inopiné Extrahospitalier (AIE) est une problématique que rencontrent les médecins urgentistes, lors de leur pratique en Structure Mobile d’Urgence et de Réanimation (SMUR). Ils sont peu confiants pour ces interventions devant la faible incidence, (0.64 % des accouchements selon l’Enquête Nationale Périnatale de 2021) mais aussi par un manque de formation. Ces AIE sont peu étudiés dans la littérature française. Objectifs Décrire les caractéristiques des AIE, comparer les pratiques avec et sans SMUR et identifier les facteurs de risque de complications materneo-fœtales. Matériel et méthodes Les données ont été recueillies à partir de l’Observatoire des AIE. L’analyse a porté sur 3 473 parturientes entre octobre 2011 et juin 2024. Résultats L’âge maternel était de 32,0±5,4 ans (15–49), avec une parité moyenne de 2,6±1,3 (1–10). L’âge gestationnel était de 39,1±2,3 semaines. La plupart des grossesses étaient à faible risque (84 %). Les nouveau-nés étaient eutrophiques (poids à la naissance 3 131,6±550,0g, 400–5000). L’hypothermie a touché 63 % des nouveau-nés (n=1256). Seulement 27 % des mères ont reçu une analgésie adéquate. La délivrance dirigée n’a été réalisée que dans 51 % des cas (n=519). Les AIE, sans SMUR, étaient corrélées à un risque plus important d’hypothermie néonatale (2,02 [1,57–2,61], p<0,0001) à domicile et (1,56 [1,21–2,00], p=0,0005) à la maternité, à une majoration de la mesure de la glycémie (1,42 [1,14–1,77], p=0,002) et de l’aspiration nasopharyngée (0,61 [0,46–0,82], p=0,0007). Les complications maternelles représentaient 5 % (n=166) et les complications fœtales 5 % (n=186). Le taux de mortalité périnatale était de 1 % (n=38). Les complications fœtales des AIE étaient associées à la prématurité (prématurité modérée (2,86 [1,69–4,83] p<0,0001 ; prématurité sévère (25,21 [12,13–52,40] p<0,0001) et à l’hypothermie néonatale présente à la maternité (1,74 [1,10–2,76] p=0,019). Conclusion L’étude met en évidence des soins périnataux sous-optimaux. (délivrance dirigée non systématique, lutte contre l’hypothermie insuffisante). La formation préhospitalière est essentielle pour améliorer les prises en charge materno-fœtales et réduire la morbi-mortalité.

Il parto extraospedaliero improvviso è spesso rapido ed ecologico. Il punteggio predittivo dell'imminenza del travaglio (SPIA) e il punteggio di Malinas A sono strumenti di supporto decisionale per la valutazione dell'imminenza del travaglio. Non si deve scegliere di partorire durante il trasporto. La paziente deve essere posizionata in modo da rispettare la meccanica ostetrica e quindi garantire che l'asse ombelicale-coccigeo di aggancio e discesa del bambino coincida il più possibile con l'asse di spinta uterino, che è più obliquo in avanti. La persona che assiste il parto in posizione ginecologica deve essere posizionata più in basso rispetto al perineo per aiutare a liberare i diversi diametri del feto nell'asse ombelicale-coccigeo. La partoriente deve spingere solo durante le contrazioni, fino a tre sforzi per contrazione, con un'espirazione prolungata piuttosto che in apnea con la glottide chiusa. La somministrazione preventiva di ossitocina è il modo migliore per prevenire l'emorragia da parto. La diagnosi di emorragia post-partum si basa essenzialmente sull'esame clinico della paziente e sulla vigilanza dell'équipe infermieristica. Durante un parto podalico, bisogna saper aspettare, non toccare, spingere solo quando il podalico appare in corrispondenza della vulva, non tirare e accontentarsi di sostenere il bacino del bambino mentre viene a sedersi nelle mani del chirurgo. La madre e il neonato devono essere trasportati in sicurezza. Le formalità amministrative e normative devono essere completate. La conoscenza della meccanica ostetrica e l'addestramento pratico sono essenziali e la regola non è l'improvvisazione.

Unplanned out-of-hospital deliveries represent about 0.3% of all deliveries in France. The management of newborns in prehospital care by a mobile intensive care unit is part of the routine activity. The initial assessment of the newborn systematically includes measuring the heart rate (HR) and respiratory rate (RR), assessing the tone, and measuring the axillary temperature. In case of doubt or incomplete transition, cardiorespiratory monitoring will be immediately set up (HR, RR, SpO(2)). We review the known data and have adapted them, if necessary, to the out-of-hospital setting, as the majority of the data reported in the literature concerns maternity care or hospital care. We address essential points in the management of newborns, namely cardiopulmonary resuscitation, delayed umbilical cord clamping, the control of hypothermia and hypoglycaemia; as well as particular situations such as prematurity, meconium fluid, or congenital malformations. We also propose the equipment necessary for the management of newborns outside the hospital, different criteria for the engagement of an outof-hospital paediatric support as well as the techniques of ventilation and vascular access that the emergency physician must master. The objective of this update is to propose the most appropriate management of the prehospital setting.

Objective: To provide recommendations on the management of obstetrical emergencies outside the maternity hospital Design: A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Resuscitation (SFAR) and the French National College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process and the process was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of making strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded. Methods: Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. The analysis of the literature and the formulation of recommendations were conducted according to the GRADE method. Results: Fifteen recommendations formulated on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by these same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all recommendations. Finally, for two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made. Conclusions: There was significant agreement among the experts on strong recommendations to improve practice in the management of obstetric complications in emergency medicine.

Les accouchements inopinés extrahospitaliers représentent environ 0,3 % des accouchements en France. La prise en charge du nouveau-né en préhospitalier par une équipe Smur fait partie de l’activité courante. L’évaluation initiale du nouveau-né comprend systématiquement la mesure de sa fréquence cardiaque (FC) et respiratoire (FR), l’appréciation de son tonus ainsi que la mesure de sa température axillaire. En cas de doute ou de transition incomplète un monitoring cardiorespiratoire sera immédiatement mis en place (FC, FR, SpO2). Nous faisons ici une mise au point sur les données connues et avons adapté les pratiques, si besoin, au contexte extrahospitalier, car la majeure partie des données rapportées dans la littérature concernent les prises en charge en maternité ou en milieu hospitalier. Nous abordons les points essentiels de la prise en charge des nouveau-nés, à savoir la réanimation cardiopulmonaire, le clampage tardif du cordon ombilical, la lutte contre l’hypothermie et l’hypoglycémie; ainsi que des situations particulières comme la prématurité, la conduite à tenir en cas de liquide méconial ou de certaines malformations congénitales. Nous proposons aussi quels peuvent être : le matériel nécessaire à la prise en charge des nouveau-nés en extrahospitalier, les critères d’engagement d’un renfort pédiatrique à la régulation ainsi que les méthodes de ventilation et d’abord vasculaire que l’urgentiste doit maîtriser. L’objectif de cette mise au point est de proposer des prises en charge les plus adaptées au contexte préhospitalier.

Les trottinettes connaissent un engouement croissant avec la mise en place des trottinettes en libre-service. Toutefois, leur usage n’est pas sans conséquence sur le risque traumatique. Cette étude a pour objectif de décrire la population et les types de lésions des usagers de trottinettes. Matériel et méthode : Les données proviennent du registre des victimes d’accident de la circulation du département du Rhône qui inclut toute personne blessée ou tuée à la suite d’un accident de la route survenu dans le département du Rhône et pris en charge dans une structure sanitaire privée ou publique. La période étudiée concerne l’année 2019. Les informations recueillies concernent les caractéristiques individuelles, accidentelles, lésionnelles de la victime ainsi que son devenir. Les lésions sont codées grâce à l’Abbreviated Injury Scale (AIS). Les blessés graves sont définis par des lésions d’AIS 3 et plus. Résultats : Au total, 1 186 accidents de trottinette ayant entraîné 1 197 usagers blessés ont été recensés, dont 90 % dans l’hypercentre urbain, avec un nombre d’accidents de trottinettes multiplié par 7,3 entre 2018 et 2019. Cette augmentation a été observée depuis l’été 2018 avec l’introduction de sociétés proposant des locations de trottinettes. L’accident s’est produit seul, sans antagoniste dans 77 % des cas (n = 920). Le port du casque était rare (n = 72 ; 6 %). La grande majorité (n = 869 ; 73 %) des blessés était âgée de 10 à 34 ans, et les 20 à 24 ans (n = 301) représentaient le quart de l’effectif. Pour 11 accidents, il y avait deux blessés usagers de la même trottinette. Il y avait en moyenne deux lésions par victime. Les atteintes graves (MAIS 3 et plus) représentaient 3,8 % des lésions, et il n’y avait pas de différence statistiquement significative pour les lésions graves entre trottinette électrique et trottinette à propulsion humaine (p = 0,20). Comparées aux lésions des cyclistes dont les caractéristiques des accidents sont proches, les blessures de l’extrémité céphalique prédominent chez les usagers de trottinette (37 vs 27 % ; p < 0,001). Conclusion : Devant l’utilisation grandissante des trottinettes parmi les modes de déplacement, une évaluation scientifique des victimes de traumatismes est nécessaire pour proposer des recommandations visant à limiter les traumatismes graves. Ce travail constitue une première étape vers la surveillance épidémiologique tant en termes de recommandations que d’évolution.

Aim: We aimed to describe the population and the types of injuries of scooter users.Methods: Our retrospective observational study relied on the register of road accident victims of 2019 that includes all victims of road accidents admitted in public or private hospital emergency departments of the Rhone administrative county (France). We studied characteristics of scooter accidents, of victims and of their injuries. We used the abbreviated injury scale (AIS 2005) to describe injuries, and the maximum abbreviated injury scale (MAIS) to define the most severe injury for multi-traumatized victims.Results: In 2019, 1,197 scooter-related victims were identified, and 90% (N = 946) occurred in the hyper-urban center. The total number of accidents related to scooters increased by 7.3% compared to before the introduction of electric scooters for rent. Nearly 77% (N = 920) of the accidents involved the rider only. Only 6% (N = 72) of the injured riders were wearing a helmet at the time of the injury. Most of the injured people (73%) were in the 10-34 years range (N = 869), and a quarter of injured riders (25%) were aged 20-24 years (N = 301). Riders experienced two injuries on average. Severe injuries (MAIS = 3) represented 3.8% of injuries and there was no statistically significant difference between electric and human powered scooters (P = 0.2). The rate of head injuries was higher in injured scooter riders compared with injured cyclists, whose accident characteristics can be considered as very similar (37 vs. 27%; P < 0.001).Conclusion: The sharp increase of injured scooter riders, and the extent of injuries that affect the skull and the face calls for new safety recommendations about protective gear and riding regulations.

I traumi nella donna in gravidanza sono situazioni potenzialmente gravi per la madre e per il bambino. Le conseguenze sul feto, in particolare il distacco della placenta, possono essere riscontrate per traumi minori. Una buona conoscenza delle modificazioni fisiologiche legate alla gravidanza è necessaria per la gestione. Il feto dipende totalmente dalla stabilità delle funzioni vitali materne. Per tutte le decisioni terapeutiche, la madre rimane la priorità, qualunque sia la situazione. Sono indispensabili un orientamento appropriato e una gestione multidisciplinare.

Prehospital births are fairly rare in Sweden but occasionally occur in the ambulance care system. The ambulance nurse's experience of prehospital births has previously been studied, but there is a lack of research that depicts the woman's perspective of a prehospital birth.To describe women's experiences of unplanned prehospital births.A qualitative questionnaire consisting of six open-ended questions that encouraged participants to describe their prehospital-birth experience. Eight women answered the survey and nine birth stories were included. A qualitative content analysis with an inductive approach was used as an analysis method.The analysis of the texts resulted in four main categories. The main categories were an unpredictable event, the woman's suffering, her perceived gratitude and the importance of the ambulance nurse now and in the future. The main category of women's suffering resulted in two subcategories: physical stresses and psychological and emotional suffering.The women are not prepared to give birth to a child outside the hospital, and the course of events happen quickly. A prehospital birth is described as a tumultuous event for women. The ambulance nurse has a central role in the care outside the hospital. The advice women suggest to ambulance nurses are remaining calm and safe no matter what the situation looks like, listening to the mother and meeting the woman's wishes. Proposals for further research are to investigate the importance of further education in childbirth care for ambulance nurses and how that affects the care of women and their family.

Objectives. -To estimate the frequency of accidental out-of-hospital deliveries (OHDs), to describe the home care and the complications occurred, and to identify risk factors.Materials and methods. -A retrospective case-control study from 1st January 2012 to 31 December 2012 in Lyon urban area. Cases were identified from the Emergency Medical Aid Service 69 (SAMU 69) registry and control from the birth registry of the maternity corresponding to the case, recruiting two controls per case.Results. -The frequency of the OHDs was 0.3% [0.2-0.4]. At home, the prophylactic administration of oxytocin was performed in 18.3% [9.31-27.3] of cases and prevention of neonatal hypothermia was performed in 45.7% [34.1%-57.3%] of cases. Multiparity [OR: 3.43 (1.65-7.23)], a precarious situation [OR: 37.63 (5.02-7.81)], and lack of antenatal care [OR: 3.36 (2.72-4.15)] were OHDs' risk factors.Conclusion. -The practical prevention of postpartum hemorrhage, and that of the home neonatal hypothermia could be improved. Points of vigilance for the medical teams to look for during the pregnancy monitoring are precariousness and less than 3 consultations scheduled. (C) 2015 Elsevier Masson SAS. All rights reserved.

G. Bagou *, B. Cabrita , P.-F. Ceccaldi , G. Comte , M. Corbillon-Soubeiran , J.-F. Diependaele , F.-X. Duchateau , O. Dupuis , V. Hamel , A. Launoy , N. Laurenceau-Nicolle , E. Menthonnex , Y. Penverne , T. Rackelboom , A. Rozenberg , C. Telion m a Samu-69, groupement hospitalier Edouard-Herriot, 3, place d’Arsonval, 69437 Lyon cedex 03, France b Samu-21, hopital general, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon cedex, France c Service de gynecologie obstetrique, hopital Beaujon, 92110 Clichy, France d Samu-Cesu-80, hopital Nord, 80054 Amiens cedex, France e Smur pediatrique, CHRU de Lille, 59037 Lille cedex, France f Smur Beaujon, hopital Beaujon, 92110 Clichy, France g Service de gynecologie obstetrique, centre hospitalier Lyon-Sud, 69495 Pierre-Benite cedex, France h Samu-44, 8, quai Moncousu, 44093 Nantes cedex 1, France i Service de reanimation chirurgicale, hopital de Hautepierre, 67098 Strasbourg cedex, France j Cellule regionale des transferts perinatals Rhone-Alpes, groupement hospitalier Edouard-Herriot, 69437 Lyon cedex 03, France k Samu-38, CHU, BP 217, 38043 Grenoble cedex 9, France l Service d’anesthesie reanimation, groupe hospitalier Cochin St-Vincent-de-Paul, 75679 Paris cedex 14, France m Samu de Paris, hopital Necker, 75743 Paris cedex 15, France