Neonatal Outcome Differences Among Providers With Lower Nulliparous, Term, Singleton Vertex Cesarean Rates [30B]

INTRODUCTION: While increasing rates of cesarean deliveries are known to be associated with worsening maternal and neonatal outcomes, it is unknown whether there are adverse effects to maternal or neonatal outcomes by significantly lowering the cesarean rate. The objective of this study was to identify whether there were differences in maternal or neonatal outcomes among providers with lower NTSV cesarean rates. METHODS: A retrospective cohort study of all providers performing deliveries at an academic, tertiary care, community hospital from 2011-2017. Efforts were ongoing to lower the hospital NTSV rate. Providers were analyzed individually and in groups according to whether their cumulative NTSV was greater or less than 23.9%. Outcomes of interest included rates of severe maternal morbidity (SMM) and indicators of neonatal morbidity: abnormal cord blood gases, 5-minute APGAR, and term neonatal intensive care unit (NICU) admission. RESULTS: 46,597 deliveries were performed by 91 unique providers. NTSV cesarean rates ranged from 7.6-68.0%. There were no differences in rates of SMM, abnormal cord blood gases or 5-minute APGAR scores. Term NICU admission rates, however, did differ: providers who had NTSV cesarean rates ≤23.9% had higher NICU admission rates compared to those whose NTSV cesarean rate was >23.9% (6.55% vs 4.54%), though this was not statistically significant. Analyzed at an individual provider level, there was a statistically significant positive correlation between NTSV cesarean rates and NICU admission (p=0.006). CONCLUSION: Providers with lower NTSV cesarean rates were noted to have higher term NICU admission rates.