Placental Delivery Before Versus After Hospital Arrival İn Unplanned Out-Of-Hospital Births: Maternal And Neonatal Outcomes İn A Single-Center Retrospective Cohort Study

Background: Unplanned out-of-hospital birth (OOHB) is associated with increased maternal and neonatal morbidity, largely due to limited access to professional obstetric support. In this context, leaving the placenta in situ in the prehospital setting may influence outcomes and represents an important clinical question. Objective: To evaluate the association between the site of placental delivery (in-hospital vs. out-of-hospital) and maternal and perinatal outcomes among women with unplanned out-of-hospital births. Methods: In this retrospective cohort study, 34,724 deliveries between January 1, 2015 and January 31, 2025 were screened, and 197 eligible cases were included in the analysis. Cases were stratified according to the site of placental delivery into two groups: in-hospital placental delivery and out-of-hospital placental delivery. Demographic, obstetric, maternal, and neonatal variables were compared in accordance with the STROBE reporting guideline. Results: Placental delivery occurred out of hospital in 62.9% of cases. The out-of-hospital placental delivery group had a significantly greater postpartum hemoglobin decline (1.77 ± 0.64 g/dL vs. 1.59 ± 0.95 g/dL; p < 0.001). The overall maternal complication rate was higher in the in-hospital placental delivery group (24.7% vs. 12.1%; p = 0.020), suggesting potential referral/presentation bias toward more complex or unstable cases. There were no significant between-group differences in perinatal outcomes (stillbirth, congenital anomalies, or total neonatal complications). However, NICU admission was more frequent in the in-hospital group (39.7% vs. 24.2%; p = 0.017). After adjustment for key confounders, out-of-hospital placental delivery remained associated with lower odds of any maternal complication and NICU admission, whereas the difference in hemoglobin decline was no longer statistically significant. Conclusions: Out-of-hospital placental delivery was associated with greater maternal blood loss, likely reflecting suboptimal third-stage management in the prehospital setting. Nevertheless, perinatal outcomes appeared to be driven largely by the overall circumstances of delivery. Leaving the placenta in situ may serve as a short-term stabilization strategy in resource-limited emergencies; however, active management of the third stage of labor should be initiated promptly upon hospital arrival.