631 Accuracy of patient self-report for indication for primary cesarean

Abstract

Obstetric and clinical factors have been associated with the likelihood of VBAC. Counseling in a subsequent pregnancy may rely on self-report if records are not available. We sought to determine the accuracy of patient self-reported history and identify factors associated with incorrect reporting. This was a secondary analysis of the previously published PROCEED trial, a multi-centered randomized controlled trial of the impact of a patient centered decision app on rates of TOLAC. Women randomized to the intervention arm entered their histories into the app to allow for calculation of the likelihood of VBAC based on the NICHD VBAC calculator. The accuracy of patient self-report was assessed, and clinical and sociodemographic factors associated with a discrepancy between patient report and chart review (considered the gold standard) were identified. Among the 720 women for whom self-report data were available, 85.4% accurately reported the indication for their primary CD. Among the 105 women with a mismatch between their self-report and the chart abstraction data regarding indication for CD, 51 did not recall their prior arrest disorder and 54 reported their indication for CD was arrest when it was not. Prior CD in labor was associated with higher likelihood of inaccurate self-report, as was lower family income level; time since delivery was not associated with inaccuracy, nor was any other sociodemographic or clinical characteristics (Table 1). The majority of women accurately reported their indication for primary CD during a subsequent pregnancy. However, among those with inaccurate reports, it was equally common for women to either incorrectly report or not report an arrest indication. Optimizing communication regarding the clinical findings at the time of initial CD for all populations may help to improve patient-centered, evidence-based counseling in subsequent pregnancies.