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430: Standardizing the response to category II tracings during induction with oxytocin: a cost-effectiveness analysis
Poster Session II
ajog.org
neonatal morbidity and mortality. Further work on this guideline should be performed to ascertain how the approach using different aspects of the category II tracing to guide care might lead to similar improved outcomes without increasing the cesarean delivery rate.
430 Standardizing the response to category II tracings during induction with oxytocin: a costeffectiveness analysis Louisa R. Chatroux1, Blake Zwerling2, Leah M. Savitsky1, Justin Williams1, Alison G. Cahill3, Aaron B. Caughey1 1
Oregon Health and Science University, Portland, OR, 2Stanford School of Medicine, Palo Alto, CA, 3Washington University, St. Louis, MO
OBJECTIVE: Oxytocin is one of the most frequently used agents in obstetrics. It is generally considered to be safe and effective for induction and augmentation of labor but has been implicated in uterine hyperstimulation and adverse fetal outcomes. However, the management of labor with oxytocin in response to changes in fetal status remains an area of debate. This study sought to assess the costeffectiveness of reducing or ceasing oxytocin administration in response to category II fetal heart rate tracings during induction of labor. STUDY DESIGN: A decision-analytic model was built using TreeAge software with probabilities, costs and utilities derived from the literature. Primary outcomes included: cerebral palsy (CP), neonatal mortality, and mode of delivery. Secondary outcomes included: cost per quality-adjusted life year (cost-effectiveness threshold set at $100,000/quality-adjusted life year (QALY), admission to the NICU, low 5 minute Apgar score (<7). Sensitivity analyses were performed to determine the robustness of our baseline assumptions. RESULTS: In a theoretical cohort of 900,000 women, representing the estimated number of women undergoing induction at term in the U.S., decreasing or stopping oxytocin in response to category II tracings for patients undergoing induction of labor prevented 12,510 NICU admissions, 4,410 low Apgar scores, 204 neonatal deaths, and 126 cases of cerebral palsy (Table). However, there were 81,900 more cesarean deliveries. The strategy cost $347 million more, but was cost-effective with an ICER of $8,680 per QALY. Sensitivity analysis revealed that the intervention would be cost-effective up to a cesarean rate of 55.1%. CONCLUSION: Decreasing or stopping oxytocin in response to category II fetal heart rate tracings is cost-effective. This intervention increases the rate of cesarean deliveries but reduces
431 Pregnancy outcomes after cerclage revision Avick G. Mitra1, Laura C. Ecklund2, Rebecca Pollack2 1
WakeMed, Raleigh, NC, 2Carolinas Healthcare System, Charlotte, NC
OBJECTIVE: To provide an estimate of pregnancy and neonatal out-
comes to be expected in patients undergoing cerclage revision. STUDY DESIGN: A retrospective chart review identified 16 consec-
utive patients who had a cerclage revision by author AGM from 2010-15. Cerclage revision was offered to patients with severe funneling with membranes at or past the prior cerclage; mean funnel length to total cervical length ratio was 19%; 5 patients had visible membranes. Patients with intrauterine infection, laboring patients, and patients with multiple gestations were excluded. 13 of 16 patients had amniocentesis to exclude infection and all patients received prophylactic, broad-spectrum antibiotics. All revisions included a bladder flap dissection to put the cerclage in the upper cervix. All prior cerclages were removed at the time
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S255
ajog.org
neonatal morbidity and mortality. Further work on this guideline should be performed to ascertain how the approach using different aspects of the category II tracing to guide care might lead to similar improved outcomes without increasing the cesarean delivery rate.
430 Standardizing the response to category II tracings during induction with oxytocin: a costeffectiveness analysis Louisa R. Chatroux1, Blake Zwerling2, Leah M. Savitsky1, Justin Williams1, Alison G. Cahill3, Aaron B. Caughey1 1
Oregon Health and Science University, Portland, OR, 2Stanford School of Medicine, Palo Alto, CA, 3Washington University, St. Louis, MO
OBJECTIVE: Oxytocin is one of the most frequently used agents in obstetrics. It is generally considered to be safe and effective for induction and augmentation of labor but has been implicated in uterine hyperstimulation and adverse fetal outcomes. However, the management of labor with oxytocin in response to changes in fetal status remains an area of debate. This study sought to assess the costeffectiveness of reducing or ceasing oxytocin administration in response to category II fetal heart rate tracings during induction of labor. STUDY DESIGN: A decision-analytic model was built using TreeAge software with probabilities, costs and utilities derived from the literature. Primary outcomes included: cerebral palsy (CP), neonatal mortality, and mode of delivery. Secondary outcomes included: cost per quality-adjusted life year (cost-effectiveness threshold set at $100,000/quality-adjusted life year (QALY), admission to the NICU, low 5 minute Apgar score (<7). Sensitivity analyses were performed to determine the robustness of our baseline assumptions. RESULTS: In a theoretical cohort of 900,000 women, representing the estimated number of women undergoing induction at term in the U.S., decreasing or stopping oxytocin in response to category II tracings for patients undergoing induction of labor prevented 12,510 NICU admissions, 4,410 low Apgar scores, 204 neonatal deaths, and 126 cases of cerebral palsy (Table). However, there were 81,900 more cesarean deliveries. The strategy cost $347 million more, but was cost-effective with an ICER of $8,680 per QALY. Sensitivity analysis revealed that the intervention would be cost-effective up to a cesarean rate of 55.1%. CONCLUSION: Decreasing or stopping oxytocin in response to category II fetal heart rate tracings is cost-effective. This intervention increases the rate of cesarean deliveries but reduces
431 Pregnancy outcomes after cerclage revision Avick G. Mitra1, Laura C. Ecklund2, Rebecca Pollack2 1
WakeMed, Raleigh, NC, 2Carolinas Healthcare System, Charlotte, NC
OBJECTIVE: To provide an estimate of pregnancy and neonatal out-
comes to be expected in patients undergoing cerclage revision. STUDY DESIGN: A retrospective chart review identified 16 consec-
utive patients who had a cerclage revision by author AGM from 2010-15. Cerclage revision was offered to patients with severe funneling with membranes at or past the prior cerclage; mean funnel length to total cervical length ratio was 19%; 5 patients had visible membranes. Patients with intrauterine infection, laboring patients, and patients with multiple gestations were excluded. 13 of 16 patients had amniocentesis to exclude infection and all patients received prophylactic, broad-spectrum antibiotics. All revisions included a bladder flap dissection to put the cerclage in the upper cervix. All prior cerclages were removed at the time
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S255