Rates of Indicated Nulliparous, Term, Singleton, Vertex Cesarean Deliveries Among Practice Models [31P

Abstract

INTRODUCTION: There has been an increased focus on strategies to reduce the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rate since March 2014 when the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine published Obstetric Care Consensus (OCC) guidelines on the safe prevention of the primary cesarean delivery. The purpose of this study was to determine if performance of NTSV cesarean deliveries meeting OCC guidelines differed between provider practice models at Virginia Hospital Center (VHC). METHODS: We conducted an IRB-approved retrospective cohort study of all NTSV cesarean deliveries from January 2014 to December 2017 at VHC. A third-party reviewer determined if the indication for each delivery met OCC guidelines. Adherence was compared according to practice model (in-house providers with resident involvement, in-house providers without resident involvement, and non-in-house providers without resident involvement). Fisher exact test was used to determine whether performance of NTSV cesarean deliveries meeting OCC guidelines differed among practice models. RESULTS: There were 1,833 NTSV cesarean deliveries, of which 743 (40.5%) met OCC guidelines for delivery and 1,090 (59.5%) did not. Performance of NTSV cesarean deliveries meeting OCC guidelines was statistically different among provider practice models. Providers without resident involvement, in-house providers without resident involvement, and in-house providers with resident involvement had 37% (472 out of 1,271), 47% (178 out of 379), and 51% (93 out of 183), respectively, of NTSV cesarean deliveries meeting OCC guidelines (P<.001). CONCLUSION: In-house provider coverage and resident involvement are associated with increased performance of NTSV cesarean deliveries meeting OCC guidelines.