(983) Maternal characteristics associated with delivery versus expectant management when presenting with term decreased fetal movement

This was a retrospective cohort study of patients with singleton gestations delivering at a large hospital system from 2013-2023. Using electronic medical records, patients presenting with the chief complaint of DFM at >37 weeks gestation were identified. Using timestamps, latency between DFM presentation and delivery admission was calculated. Patients were grouped into 3 categories: 1) < 24 hours, 2) 24-48 hours, 3) >48 hours. For patients who presented with DFM more than once beyond 37 weeks, the presentation most proximal to delivery was used to calculate time to admission. Comparisons across the categorical measure of time to admission were performed using chi-square tests and multinomial logistic regression, where delivery admission >48 hours is the referent category.

Results: Of the 2,015 patients, 193 (9.6%) were admitted for delivery at < 24 hours, 131 (6.5%) between 24-48 hours, and 1,691 (83.9%) at >48 hours. Patients with non-commercial insurance, Black non-Hispanic or Hispanic, BMI ≥30 at delivery, non-English speaking, with chronic hypertension or hypertensive disorders of pregnancy or with pregestational diabetes were significantly more likely to be admitted >48hours than within 24 hours or within 24-48 hours.  Conversely, patients who conceived via IVF were more likely to be admitted within 24 hours than within 24-48 hours or after 48 hours. Following adjustment, non-commercial insurance was associated with reduced odds of admission < 24 hours, aOR=0.47 (95% CI 0.30-0.71) and reduced odds of admission 24-48 hours, aOR=0.20 (95%CI 0.12-0.32).

Conclusion: Among patients presenting with DFM to triage at term, there are significant sociodemographic and clinical variations between those admitted < 24 hours, 24-48 hours, and >48 hours. Even after adjustment, non-commercial insurance was significantly associated with decreased likelihood of admission prior to 48 hours.