Characterizing Relationships Between Prenatal Care and TOLAC Outcomes in an Urban Population [07P

Abstract

INTRODUCTION: Several studies have been published on factors predicting success rates of Trial of Labor after Cesarean section (TOLAC). Limited data exists on the relationship between prenatal care provider type and sufficiency of prenatal care. The purpose of this study is to evaluate the relationship between prenatal care provider and TOLAC outcomes. METHODS: Retrospective comparative analysis was performed on 289 charts. IRB approval was obtained. Criteria included patients delivered between 2013–16 with Singleton gestation, vertex presentation and at least 1 prior cesarean section attempting TOLAC at our institution. Exclusion criteria included multiple gestations, still birth and contraindications to vaginal delivery. ANOVA tests were used for the continuous variables and Chi-square test or Fisher's exact test were used for categorical variables. P-value <.05 considered for statistical significance. RESULTS: A total of 289 charts were reviewed. 176 patients achieved Vaginal Birth After Cesarean section (VBAC). Patients who received prenatal care from Physicians had higher VBAC rates when compared to patients who received care from CNMs at our institution (P<.0002). No statistically significance between TOLAC success and sufficiency of prenatal care was noted. There were no statistical differences between the two groups regarding Age, BMI, Race, Co-morbidities, IUGR, Calculated success scores. CONCLUSION: This study sheds light on relationship between providers, type of prenatal care and VBAC rates, a rarely explored area in TOLAC research. The results are from a single institution that functions as a staff model. Larger multi institutional prospective trials are necessary to prove or disprove results.