832: Preventing the primary cesarean in practice: evaluating adherence to ACOG/SMFM guidelines at a single institution

Abstract

A consensus paper published in 2014 by ACOG and SMFM offers new criteria for diagnosing arrest of dilation (AOD) and failed induction of labor (FIOL), with the aim of reducing the primary Cesarean delivery (CD) rate. The objective of this study is to determine the rate of adherence to these guidelines for diagnosing FIOL and AOD at an urban academic institution, and to analyze adherence to guidelines with regard to patient characteristics, obstetric outcomes, and physician CD rates. Retrospective cohort review of all singleton primary CDs at a single urban academic institution from March 1st 2014 to May 31st 2016 for FIOL and AOD. Cases were defined as being adherent or non-adherent to guidelines. Individual physician CD rates were obtained from institutional records. Univariate and multivariate analyses were carried out to compare the association of adherence to guidelines with physician CD rates, maternal characteristics, and obstetric outcomes. Out of 591 cesarean deliveries included in this study, 123 (21%) were adherent to ACOG/SMFM guidelines: 48/263 (18%) for FIOL and 75/328 (23%) for AOD. 89/253 (35.2%) of non-adherent AOD sections were performed in the latent phase. There were no differences between adherent and non-adherent CDs with regard to maternal characteristics, or obstetric or neonatal adverse outcomes (Table 1). Duration of oxytocin use after rupture of membranes, dilation at time of CD, and mean birth weight were statistically higher in adherent CDs. In a multivariate linear regression physician CD rates were inversely correlated with adherence to ACOG/SMFM guidelines (p<0.0001), gestational age (p=0.007), and parity (p=0.003). Physician adherence to ACOG/SMFM guidelines at our institution is low. Adherence to these guidelines is associated with lower physician CD rates, without an increase in obstetric or neonatal complications. Future focus should be on physician education regarding ACOG/SMFM guidelines in order to decrease the rate of primary CD.