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2: Resource utilization among low-risk nulliparas randomized to elective induction at 39 weeks or expectant management

      Objective

      To evaluate medical resource utilization for low–risk nulliparous women randomized to elective induction of labor (IOL) at 39 weeks compared to those randomized to expectant management (EM).

      Study Design

      Planned secondary analysis of a multi-center RCT in which low-risk nulliparous women were assigned to IOL at 390/7- 394/7 weeks or EM. Resource utilization after randomization was categorized a priori according to when resources were used – antepartum, delivery admission, and from discharge until through 8 weeks postpartum – and compared according to group assignment.

      Results

      Of 6096 women with data available, 3059 were randomized to IOL and 3037 to EM. During the antepartum period, after randomization, those in the IOL group were less likely to have at least one ambulatory visit for routine prenatal care, for unanticipated office care, or to urgent care/ED/triage, as well as to have an inpatient admission for at least one day (Table 1, p < .001 for all). These cumulatively accounted for 3650 fewer ambulatory visits, 40 fewer inpatient days, and 2072 fewer blood, sonogram, and antenatal surveillance tests for women in the IOL group prior to delivery (Table 2). During the delivery admission, women in the IOL group spent a longer duration in L&D, and received cervical ripening, oxytocin, and IUPCs more frequently; conversely, they received fewer MgSO4 and antibiotic infusions, had a shorter postpartum stay, and had neonates who less frequently used CPAP/HFO2 and who had shorter hospital stays (Table 1, P < .05 for all). Neonates in the IOL group were more likely to have ≥1 ambulatory office visit other than for routine neonatal care (Table 1, p < .05); otherwise, women and neonates in both groups had similar frequencies of postpartum urgent care or ED visits, and hospital readmissions (p > .05 for all).

      Conclusion

      Although women randomized to IOL spent more time in L&D and used more resources specific to IOL (e.g., cervical ripening), they had significantly fewer antepartum visits and tests, intrapartum therapeutic interventions (e.g., MgSO4) and shorter postpartum maternal and neonatal hospital stays. Thus, the antepartum and postpartum burden of resource utilization related to EM of low-risk nulliparous women beyond 39 weeks is substantial, and is important to account for in comparing.
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