on labor and delivery, and was administered in Southern California. (Regional Perinatal Programs, regions 6-9). Hospital-level VBAC rates were obtained from ...
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Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues
an increased CA hazard (1.44) without a significant association with SPTB. Bleeding was associated with a significant increase in PA hazard though negative or neutral associations with other outcomes. CONCLUSION: For patients with PPROM, the hazards associated with different clinical predictors vary according to exact outcomes.
496 The laborist on labor and delivery: is this new trend associated with higher rates of VBAC? Daniele Feldman1, D. Lisa Bollman4, Lisa Korst2, Moshe Fridman3, Samia El Haj Ibrahim1, Kimberly Gregory1 1
Cedars Sinai Medical Center, OB/Gyn, Maternal Fetal Medicine, Los Angeles, CA, 2Childbirth Research Associates, Los Angeles, CA, 3AMF Consulting, Los Angeles, CA, 4Community Perinatal Network, Yorba Linda, CA
OBJECTIVE: To determine whether the use of laborists affected vaginal
birth after cesarean (VBAC) rates. STUDY DESIGN: A structured interview was designed and validated to
collect information from nurse managers regarding clinical practices on labor and delivery, and was administered in Southern California (Regional Perinatal Programs, regions 6-9). Hospital-level VBAC rates were obtained from the Office of Health Planning and Development. Recursive partitioning algorithms were used to test whether the outcome of successful VBAC was associated with the use of laborists, the presence of an OB/Gyn residency program (teaching), and volume (Low volume [LV]¼200-2000; Mid volume [MV]¼ 2001-3500; High volume [HV]¼ >3500 deliveries/year) Analysis was weighted by delivery volume. Logistic regression was performed to confirm results. RESULTS: The response rate was 70% (84/121); 32 hospitals were excluded (did not allow VBAC). Of the remaining 52 hospitals, teaching hospitals (N¼13, 25%) had higher VBAC rates (15.3% vs. 5.6%, P < 0.001). Among teaching hospitals, smaller hospitals had higher VBAC rates: LV: 22.5%; MV: 20.7%; and HV: 12.9%, P < 0.001. Among non-teaching hospitals (N¼39, 75%), those with a laborist had higher VBAC rates (6.8% vs. 3.7%, P < 0.001). Among hospitals with laborists (N¼19), VBAC rates were associated with lower delivery volume: LV: 8.8%; MV: 6.1%; and HV: 6.9%, P < 0.001. Among non-teaching hospitals without laborists (N¼20), VBAC rates were lower and delivery volume had a less pronounced association: LV: 3.5%; MV: 4.4%; and HV: 2.0%, P < 0.001. Logistic regression confirmed these results. CONCLUSION: VBAC rates were highest in hospitals with OB/Gyn residency programs. In non-teaching hospitals, VBAC rates were highest in hospitals with a laborist, and were associated with delivery volume. These findings suggest the presence of a laborist is associated with hospital policies and practices. Future research should evaluate maternal and neonatal outcomes in the setting of this new model of care.
497 Amniocentesis rates and genetic screening initiatives in a single center over a nine year period; is there a correlation? Malgorzata Mlynarczyk1, Letty Romary1, Sebastian Larion1, Steven Warsof1, Alfred Abuhamad1 1
EVMS, Ob/Gyn, Norfolk, VA
OBJECTIVE: The introduction of nuchal translucency (NT) and first trimester screening (FTS), as recommended by ACOG (Practice Bulletin #77), have allowed earlier detection of chromosomal anomalies. Recently, non-invasive prenatal testing (NIPT) has further improved genetic screening through increased sensitivity and decreased false positives (ACOG Committee Opinion #545). The effect that these changes have had on diagnostic procedures has not
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been evaluated. We show here the number and rates of amniocentesis (AMN) following FTS and NIPT implementation in a single referral center. STUDY DESIGN: Monthly AMN procedures and genetic consults were recorded between July 2004 and June 2013 using billing information from a single outpatient clinic. The number and rates of AMN were compared for 3 time periods: (1) before FTS was offered [July 2004December 2006], (2) after FTS was offered but before NIPT [January 2007-February 2012], and (3) after NIPT introduction [March 2012June 2013]. Results were compared using one-way ANOVA with significance at P
