933 Maternal and infant outcomes in those undergoing TOLAC by hospital volume

Abstract

This study assessed whether maternal and neonatal outcomes in those undergoing trial of labor after cesarean (TOLAC) differ significantly between hospitals of different volumes. We conducted a retrospective cohort study of singleton, non-anomalous, term deliveries in California between 2007 and 2011. We studied outcomes stratified by low, medium, and high hospital volume based on previous literature. 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 met our inclusion criteria. The odds of operative vaginal delivery in women undergoing TOLAC were significantly higher at high volume hospitals compared to low and medium volume hospitals (aOR: 1.65 vs 0.94 and 1.00, respectively). Rates of post-partum hemorrhage were significantly different, with highest rates in high volume hospitals (3.24%) compared with medium and low volume centers (2.68% and 2.46%, respectively). Transfusion rates were also significantly different. Rates of severe maternal morbidity, endometritis, and placental abruption were not significantly different. For neonates, rates of neonatal intensive care unit (NICU) admission was highest in medium volume centers (7.8%) compared to low and high (6.56% and 6.91%, respectively). APGAR scores <7 at 5 minutes were significantly different between groups, and highest at medium volume centers (0.63%) when compared to low and high (0.60% and 0.40%, respectively). There was no significant difference in brachial plexus injuries, HIE, neonatal or infant death between groups. In women undergoing TOLAC, most outcomes were not different. However, there was a significantly higher rate of post-partum hemorrhage and maternal blood transfusion between hospital volume categorizations. Of the outcomes studied, NICU admission and low APGAR scores were the only outcomes that were significantly different. Whether or not VBAC success rate is contributing to the lack of complications seen needs to be studied further.View Large Image Figure ViewerDownload Hi-res image Download (PPT)