1164 Maternal and infant outcomes in those undergoing TOLAC by hospital setting

Abstract

The objective of this study was to assess whether maternal and neonatal outcomes in those undergoing trial of labor after cesarean (TOLAC) differ significantly between hospitals in rural versus urban settings. We conducted a retrospective cohort study of singleton, non-anomalous, term deliveries in California between 2007 and 2011. We compared maternal and neonatal outcomes separately between rural and urban settings. Chi-square and multivariable logistic regression analyses were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. 45,763 women-infant dyads were included in this study. We found the odds of operative vaginal delivery in women undergoing TOLAC were significantly higher at urban centers compared to rural hospitals (aOR: 1.00% vs 0.46%, p<0.001). In women undergoing TOLAC, rates of endometritis were significantly higher at urban hospitals than rural (0.62% vs. 0.24%, p=0.049). Rates of post-partum hemorrhage was significantly higher at urban hospitals than rural (3.07% vs 1.90%, p=0.006), although maternal transfusion rates were not significantly different. Rates of placental abruption were not significantly different between the two settings. Infants of women undergoing TOLAC were admitted to the neonatal intensive care unit (NICU) at a significantly higher rate in urban hospitals than rural hospitals (7.28% vs 3.90%, p<0.001). The remaining outcomes were not significantly different, including rates of low APGAR scores, brachial plexus injury, HIE, neonatal and infant death. In this study, we found that most outcomes in women undergoing TOLAC did not differ significantly between rural and urban settings. At hospitals in urban settings, women experienced higher rates of endometritis and post-partum hemorrhage. Neonatal outcomes were also generally not significantly different, however, infants of women in urban settings experienced higher rates of NICU admission than rural hospitals. Further research ought to be done to determine whether VBAC success rates contribute to these differences.View Large Image Figure ViewerDownload Hi-res image Download (PPT)