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40: Implementation of an induction calculator as standard of care reduces maternal morbidity

      Objective

      We previously created and validated a calculator which provides an individual cesarean risk score for women undergoing induction [Levine 2017]. A higher risk of cesarean delivery (CD) on the calculator has been associated with increased maternal morbidity. We aimed to determine if implementation of this calculator into usual care could impact maternal morbidity.

      Study Design

      We performed a prospective cohort study evaluating maternal morbidity (see Table) after implementation of the induction calculator into clinical care. We compared 1-year prior to implementation (PRE:7/2017-6/2018) to 1-year after (POST:7/2018-6/2019). In the POST period, patients and providers were aware of calculated CD risk, which was incorporated into care at their discretion. Secondary outcomes included CD rate, time to CD, neonatal morbidity, and Birth Satisfaction Scale-Revised scores. Analysis was stratified by risk of CD based on calculator results (< 20%, 20-39.9%, 40-59.9%, ≥60%).

      Results

      1610 women were included (PRE=788; POST=822) without significant baseline differences except fewer inductions >40 weeks in the POST group. After calculator implementation, maternal morbidity decreased overall, even when adjusting for gestational age at delivery (aOR=0.60[0.46-0.80]; Table). In women with calculated CD risk < 20%, CD rate decreased PRE to POST (12.8% vs. 6.4%, p=0.01), with a reduction in maternal morbidity (12.8% vs. 6.8%, p=0.02). Notably, cesareans for failed induction were eliminated in this group (2.9% vs. 0%). In those with calculated CD risk ≥60%, there was no difference in CD rate (61.1% vs. 52.6%, p=0.37); however, time to CD decreased PRE to POST (26.2 vs. 21.1hrs, p=0.05) with a reduction in maternal morbidity (27.8% vs. 14.0%, p=0.07). There were no differences in neonatal morbidity. Birth satisfaction improved PRE to POST (p=0.04).

      Conclusion

      Implementation of an induction calculator is associated with reduced maternal morbidity, likely by altering labor management at the extremes of cesarean risk. Implementation should occur broadly to determine if calculator use improves national maternal outcomes.
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