467 - Maternal and Neonatal Outcomes After an Initiative to Decrease NTSV Cesarean Deliveries

Poster Number: 467
Publication Number: 467.3329

Background: Due to the rise in the rate of cesarean deliveries in recent years, ACOG proposed an initiative to reduce primary cesarean deliveries. A comprehensive initiative was consequently undertaken at our medical center to comply with the recommendation. To date, there is a paucity of data on the direct impact of decreasing cesarean deliveries on the maternal and neonatal morbidity and mortality.

Objective: To compare the incidences of maternal and neonatal morbidity and mortality before and after implementation of an initiative to decrease nulliparous term singleton vertex (NTSV) cesarean deliveries.

Design/Methods: This is a single center retrospective study comparing 2 cohorts, before (2015-2017) and after (2019-2021) a hospital-wide initiative to decrease NTSV cesarean deliveries. Optimal propensity score matching was used to match the cohorts for maternal age, gravidity, race, gestational age at delivery, pre-pregnancy BMI, hypertension, ICU admission, and insurance type. Categorical variables were compared using two-sided McNemar’s test or Bowker test of symmetry and continuous variables were compared using two-sided Wilcoxon signed rank test. Any p< 0.05 was considered statistically significant.

Results: There were 2023 NTSV deliveries with 1043 deliveries from 2015 to 2017 (pre-implementation period) and 980 from 2019-2021 (post-implementation period). After matching, the analyzed population comprised 1438 deliveries with 719 in each cohort. Maternal baseline characteristics were similar in both groups (Table 1). NTSV cesarean deliveries declined significantly between time periods in both unmatched (42.67% vs 28.88%, p< 0.001) and matched study subjects (44.78% vs 28.23%, p < 0.001). The decrease in cesarean deliveries was associated with increased rates of both maternal (49.65% vs 55.22%, p=0.04) and neonatal (15.58% vs 23.23%, p< 0.001) complications. More specifically there was an increase in neonatal intubation (0.14% vs 1.16%, p< 0.01), neonatal ICU admission (11.25% vs 17.25%, p=0.001), birth injury (2.27% vs 7.82%, p< 0.0001) and low APGAR scores (0.28% vs 1.67%, p< 0.01) (Table 2).

Conclusion(s): After matching for maternal characteristics and gestational age at delivery, a decrease in NTSV cesarean deliveries was associated with increased maternal and neonatal morbidities in a single center study. This study suggests the need for careful surveillance during progressive change in practice to decrease cesarean rates in order to reach the lowest attainable cesarean delivery rates without impacting morbidity. Further studies are needed to verify these findings.