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565: Early and late preterm delivery rates – does tocolysis matter?
Poster Session IV
Academic Issues, etc
had higher rates of the anomalies in the “no” and “passive” registry states. The lowest rates were in the “active” registry states. The trends were stable before and after 1998 (Figure).
www.AJOG.org 566 Prematurity rate and cost trends in California 1991-2006 Cheryl Walker1, Guibo Xing2, Joann Petrini3, Beate Danielsen4 1 University of California, Davis, Obstetrics & Gynecology, Sacramento, California, 2University of California, Davis, Obstetrics and Gynecology, Sacramento, California, 3March of Dimes, Connecticut, 4 Health Information Solutions, Rocklin, California
OBJECTIVE: To evaluate trends associated with premature births in
California between 1991 and 2006. STUDY DESIGN: We examined the California Office of Statewide Health
Abdominal wall defect rates from 1990 - 2005 CONCLUSION: States with “no” or “passive” CDC defined birth defect
registries had higher rates of structural anomalies on birth certificates. There was no apparent change in these trends after the introduction of enhanced surveillance in 1998. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.429
565 Early and late preterm delivery rates – does tocolysis matter? Etaoin Kent1, Karen Flood1, Julia Unterscheider1, Michael Robson2, Michael Geary3, Fergal D. Malone1 1 Royal College of Surgeons in Ireland, Dublin, Ireland, 2National Maternity Hospital, Dublin, Ireland, 3Rotunda Hospital, Dublin, Ireland
OBJECTIVE: To determine the difference in rates of preterm delivery in 2 institutions with differing policies regarding use of Tocolytic drugs for the prevention of preterm delivery. STUDY DESIGN: A retrospective study comparing preterm delivery rates between 2002 and 2007 in two large tertiary hospitals serving a single urban population. During the study period Hospital A routinely used intravenous tocolysis to treat women with threatened preterm labor less than 34 weeks. Hospital B operates a policy of never using any tocolytic drugs for the prevention of preterm delivery. Both hospitals have a similar patient population and comparable perinatal mortality rates. Both hospitals also routinely provide antenatal corticosteroids to patients with threatened preterm delivery prior to 34 weeks. Rates of delivery prior to 26 weeks, 30 weeks, 34 weeks and 37 weeks were calculated for each hospital and compared using Fishers Exact test. RESULTS: During the study period there were 90,843 deliveries between the two hospitals – 42,232 in Hospital A and 48,611 in Hospital B. The overall rates of preterm delivery at less than 37 weeks gestation were comparable with 6.62% (2,794/42,232) in Hospital A and 6.15% (2,989/48,611)in Hospital B (p ⫽ 0.99). There was no significant difference in the numbers delivering at less than 34 weeks, 995/42,232 (2.36%) vs 1,134/48,611 (2.33%), p ⫽ 0.59, less than 30 weeks, 403/ 42,232 (0.95%) vs 429/48,611 (0.88%), p ⫽ 0.87 or prior to 26 weeks, 126/42,232 (0.29%) vs 121/48,611 (0.25%), p⫽ 0.08. CONCLUSION: In this large population with overall low rates of preterm delivery routine use of tocolytic drugs in the treatment of threatened preterm labor does not alter rates of early or late preterm delivery. While this study is limited by its retrospective nature, it calls into question the practice of tocolysis. Large scale prospective studies are required to further evaluate the potential utility of tocolysis for threatened preterm labor. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.430
S210
Planning and Development linked Patient Discharge Data and Birth Cohort File from January 1, 1991 through December 31, 2006. We calculated birth and death rates, resource utilization for mothers and infants in length of stay (LOS), mean and total costs adjusted to 2008 dollars, rates of adverse outcomes, and trends over the 16-year study period. RESULTS: In CA in 2006, 9.6% of births occurred prematurely, and 78.6% of these occurred ⬎33 weeks. Preterm birth rates were static at gestational ages (GAs) ⬍34 weeks, but have risen slightly in the late preterm (LPT) period (34-36 completed weeks) and markedly in the early term (ET) period (37-38 completed weeks) during the last 16 years. While the average GA at birth has decreased, birthweights have remained stable, suggesting that norms have shifted and babies weigh slightly more at each GA. Cesarean deliveries rose to 29.9% in 2006, and over 50% among very preterm births ⬍32 weeks. Total adjusted newborn and maternal costs were substantial at nearly $4 billion for 2006, with newborn costs accounting for 44% of these costs. The 0.9% of births that occurred very prematurely at less than 32 weeks accounted for 29.2% of all newborn costs. Mean costs remain slightly elevated through the LPT and ET periods, the result of their mildly increase in LOS and co-morbid conditions. CONCLUSION: Prematurity rates ⬍34 weeks have been stable over the last 16 years despite dramatic investments in and improvements to obstetric care. Unlike national trends, rates of LPT birth have risen only slightly while ET births have risen substantially over the period of study, suggesting provider and/or consumer pressures rather than biological influences. Excess newborn and maternal economic and outcome costs continue through the late preterm and early term periods, though these additional costs are small. We need to investigate to what extent these costs might be avoidable. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.431
567 Costs related to elective early birth in California 1991-2006 Cheryl Walker1, Guibo Xing2, Beate Danielsen3, Joann Petrini4 1 University of California, Davis, Sacramento, California, 2University of California, Davis, Obstetrics and Gynecology, Sacramento, California, 3Health Information Solutions, Rocklin, California, 4March of Dimes, Connecticut
OBJECTIVE: To identify potentially avoidable late preterm (LPT) and
early term (ET) births and assess costs related to them. STUDY DESIGN: We examined the California Office of Statewide Health
Planning and Development database linking vital statistics birth and death records to maternal and neonatal–infant hospital discharge records from January 1, 1991 through December 31, 2006. Early elective births were defined as those without identifiable maternal or fetal risk delivered vaginally following induction of labor or by cesarean delivery (CD) before 39 weeks gestational age (GA). Resource utilization for mothers and infants was calculated by length of stay, mean and total costs adjusted to 2008 dollars, and rates of adverse neonatal outcome. We compared elective births with appropriate non-elective birth strata, and assessed trends over the 16-year study period. RESULTS: Between 1991 and 2006, LPT births increased slightly and ET births rose more notably. Vaginal births (VBs) fell and CDs rose from 22 to 30%. Most LPT and ET births had an indication and were not elective. Birth curves shifted to earlier GAs over the study period for all elective delivery types. Although newborn adverse outcomes
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Academic Issues, etc
had higher rates of the anomalies in the “no” and “passive” registry states. The lowest rates were in the “active” registry states. The trends were stable before and after 1998 (Figure).
www.AJOG.org 566 Prematurity rate and cost trends in California 1991-2006 Cheryl Walker1, Guibo Xing2, Joann Petrini3, Beate Danielsen4 1 University of California, Davis, Obstetrics & Gynecology, Sacramento, California, 2University of California, Davis, Obstetrics and Gynecology, Sacramento, California, 3March of Dimes, Connecticut, 4 Health Information Solutions, Rocklin, California
OBJECTIVE: To evaluate trends associated with premature births in
California between 1991 and 2006. STUDY DESIGN: We examined the California Office of Statewide Health
Abdominal wall defect rates from 1990 - 2005 CONCLUSION: States with “no” or “passive” CDC defined birth defect
registries had higher rates of structural anomalies on birth certificates. There was no apparent change in these trends after the introduction of enhanced surveillance in 1998. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.429
565 Early and late preterm delivery rates – does tocolysis matter? Etaoin Kent1, Karen Flood1, Julia Unterscheider1, Michael Robson2, Michael Geary3, Fergal D. Malone1 1 Royal College of Surgeons in Ireland, Dublin, Ireland, 2National Maternity Hospital, Dublin, Ireland, 3Rotunda Hospital, Dublin, Ireland
OBJECTIVE: To determine the difference in rates of preterm delivery in 2 institutions with differing policies regarding use of Tocolytic drugs for the prevention of preterm delivery. STUDY DESIGN: A retrospective study comparing preterm delivery rates between 2002 and 2007 in two large tertiary hospitals serving a single urban population. During the study period Hospital A routinely used intravenous tocolysis to treat women with threatened preterm labor less than 34 weeks. Hospital B operates a policy of never using any tocolytic drugs for the prevention of preterm delivery. Both hospitals have a similar patient population and comparable perinatal mortality rates. Both hospitals also routinely provide antenatal corticosteroids to patients with threatened preterm delivery prior to 34 weeks. Rates of delivery prior to 26 weeks, 30 weeks, 34 weeks and 37 weeks were calculated for each hospital and compared using Fishers Exact test. RESULTS: During the study period there were 90,843 deliveries between the two hospitals – 42,232 in Hospital A and 48,611 in Hospital B. The overall rates of preterm delivery at less than 37 weeks gestation were comparable with 6.62% (2,794/42,232) in Hospital A and 6.15% (2,989/48,611)in Hospital B (p ⫽ 0.99). There was no significant difference in the numbers delivering at less than 34 weeks, 995/42,232 (2.36%) vs 1,134/48,611 (2.33%), p ⫽ 0.59, less than 30 weeks, 403/ 42,232 (0.95%) vs 429/48,611 (0.88%), p ⫽ 0.87 or prior to 26 weeks, 126/42,232 (0.29%) vs 121/48,611 (0.25%), p⫽ 0.08. CONCLUSION: In this large population with overall low rates of preterm delivery routine use of tocolytic drugs in the treatment of threatened preterm labor does not alter rates of early or late preterm delivery. While this study is limited by its retrospective nature, it calls into question the practice of tocolysis. Large scale prospective studies are required to further evaluate the potential utility of tocolysis for threatened preterm labor. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.430
S210
Planning and Development linked Patient Discharge Data and Birth Cohort File from January 1, 1991 through December 31, 2006. We calculated birth and death rates, resource utilization for mothers and infants in length of stay (LOS), mean and total costs adjusted to 2008 dollars, rates of adverse outcomes, and trends over the 16-year study period. RESULTS: In CA in 2006, 9.6% of births occurred prematurely, and 78.6% of these occurred ⬎33 weeks. Preterm birth rates were static at gestational ages (GAs) ⬍34 weeks, but have risen slightly in the late preterm (LPT) period (34-36 completed weeks) and markedly in the early term (ET) period (37-38 completed weeks) during the last 16 years. While the average GA at birth has decreased, birthweights have remained stable, suggesting that norms have shifted and babies weigh slightly more at each GA. Cesarean deliveries rose to 29.9% in 2006, and over 50% among very preterm births ⬍32 weeks. Total adjusted newborn and maternal costs were substantial at nearly $4 billion for 2006, with newborn costs accounting for 44% of these costs. The 0.9% of births that occurred very prematurely at less than 32 weeks accounted for 29.2% of all newborn costs. Mean costs remain slightly elevated through the LPT and ET periods, the result of their mildly increase in LOS and co-morbid conditions. CONCLUSION: Prematurity rates ⬍34 weeks have been stable over the last 16 years despite dramatic investments in and improvements to obstetric care. Unlike national trends, rates of LPT birth have risen only slightly while ET births have risen substantially over the period of study, suggesting provider and/or consumer pressures rather than biological influences. Excess newborn and maternal economic and outcome costs continue through the late preterm and early term periods, though these additional costs are small. We need to investigate to what extent these costs might be avoidable. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.431
567 Costs related to elective early birth in California 1991-2006 Cheryl Walker1, Guibo Xing2, Beate Danielsen3, Joann Petrini4 1 University of California, Davis, Sacramento, California, 2University of California, Davis, Obstetrics and Gynecology, Sacramento, California, 3Health Information Solutions, Rocklin, California, 4March of Dimes, Connecticut
OBJECTIVE: To identify potentially avoidable late preterm (LPT) and
early term (ET) births and assess costs related to them. STUDY DESIGN: We examined the California Office of Statewide Health
Planning and Development database linking vital statistics birth and death records to maternal and neonatal–infant hospital discharge records from January 1, 1991 through December 31, 2006. Early elective births were defined as those without identifiable maternal or fetal risk delivered vaginally following induction of labor or by cesarean delivery (CD) before 39 weeks gestational age (GA). Resource utilization for mothers and infants was calculated by length of stay, mean and total costs adjusted to 2008 dollars, and rates of adverse neonatal outcome. We compared elective births with appropriate non-elective birth strata, and assessed trends over the 16-year study period. RESULTS: Between 1991 and 2006, LPT births increased slightly and ET births rose more notably. Vaginal births (VBs) fell and CDs rose from 22 to 30%. Most LPT and ET births had an indication and were not elective. Birth curves shifted to earlier GAs over the study period for all elective delivery types. Although newborn adverse outcomes
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009