Epidemiology
Poster Session 4
Jenny Y. Mei, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
University of California, Los Angeles
Los Angeles, CA, United States
Daniel Lee, MD
OBGYN Resident
UCLA Medical Center
Los Angeles, CA, United States
Masaru Negi, MD
Associate Professor
UCLA David Geffen School of Medicine
N Hollywood, CA, United States
Magnesium sulfate administration for preeclampsia with severe features during labor induction has been associated with increased risk of cesarean delivery (CD). We aim to evaluate provider and hospital associations with successful vaginal delivery (VD) in nulliparous patients undergoing labor induction while receiving magnesium sulfate.
Study Design:
This was a secondary analysis from the Consortium on Safe Labor, a multicenter cohort study of 228,438 deliveries in 19 U.S. hospitals. The analysis included nulliparous women ≥ 18 years old with singleton gestation undergoing induction of labor for preeclampsia with severe features and receiving magnesium sulfate. Primary outcome was physician and hospital characteristics associated with successful VD. Chi-square and independent samples t-test were used to compare groups. The study was deemed IRB exempt #20-000360.
Results: Total 4,122 women met inclusion criteria, of whom 2256 (54.7%) had a successful VD. Patients who had a VD were more likely to have had a female physician (p< 0.001), midwife or resident involvement (p< 0.001), government, OB hospitalist, or university practice model over private practice (p< 0.001), and government or hospital insurance over group or self-pay model (p=0.003). Hospital type, level of care, or types of physician coverage (MFM, hospitalist, midwife) did not differ between groups. NICU level of care did not differ between groups. The number of hospital deliveries per year was slightly lower in those with successful VDs (p< 0.001).
Conclusion:
Rates of cesarean delivery are high in patients undergoing induction of labor for severe preeclampsia receiving magnesium sulfate. Various physician and hospital characteristics are associated with increased rate of successful VD. These findings suggest the need to study practice patterns by different providers in various settings to appropriately manage labor in this high risk patient cohort.