Leah M. Savitsky

The Effect of Maternal Ethnicity on Cesarean Delivery in Macrosomic Term Pregnancies [268]

OBJECTIVE: Macrosomia is often defined as a specific birth weight threshold of 4,000 g. However, perhaps differing thresholds should be utilized by varying racial and ethnic groups if the rates of cesarean delivery vary. We sought to investigate the association between maternal race and ethnicity and cesarean delivery in the setting of macrosomia. METHODS: We performed a retrospective cohort study of nonanomalous singleton term pregnancies delivered in California between 2005 and 2008. We compared the maternal race and ethnicity—including white, African American, Hispanic, or Asian or Pacific Islander—with rates of cesarean delivery when birth weight was 4,000 g or greater stratified by parity. Multiparous women with a history of prior cesarean delivery were excluded. Outcomes were compared using the &khgr;2 test and multivariable logistic regression controlling for potential confounders. RESULTS: Among nulliparous with fetuses of 4,000 g or greater, white women had the lowest rate of cesarean delivery at 42.8% ranging up to 55.4% among Asian women (P<.001). In multiparous women, this ranged from 18.0% in white women to 32.9% in African American women (P<.001). Multivariate analyses showed that, compared with white women, the odds of cesarean delivery in African American (nulliparous odds ratio [OR] 1.69, 95% confidence interval [CI] 1.52–1.86; multiparous OR 1.97, 95% CI 1.76–2.20), Hispanic (nulliparous OR 1.49, 95% CI 1.43–1.56; multiparous OR 1.37, 95% CI 1.30–1.45), and Asian and Pacific Islander (nulliparous OR 1.60, 95% CI 1.49–1.72; multiparous OR 1.32, 95% CI 1.20–1.45) women were significantly greater and varied by race and ethnicity. CONCLUSION: Compared with white women with macrosomic pregnancies, African American, Hispanic, and Asian and Pacific Islander women with fetal macrosomia have significantly higher odds of cesarean delivery and the strength of that difference varies by race and ethnicity. Perhaps different birth weight thresholds should be utilized for different racial and ethnic groups.

Standardizing the Response to Category II Tracings during Induction with Oxytocin: A Cost-Effectiveness Analysis

Background Oxytocin is one of the most frequently used medications 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. The management of labor with oxytocin in response to changes in fetal status remains an area of debate. Objective This study sought to assess the cost‐effectiveness of reducing or ceasing oxytocin administration in response to Category II fetal heart rate tracings. Study Design A decision‐analytic model was built using TreeAge 2016 software (TreeAge Software Inc.) 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 (QALY; cost‐effectiveness threshold set at

719: Treating gestational diabetes mellitus with insulin vs glyburide: a cost-effectiveness analysis

100,000/QALY), admission to the neonatal intensive care unit (NICU), and 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 (estimated number of women undergoing induction at term in the United States), decreasing or stopping oxytocin in response to Category II tracings prevented 12,510 NICU admissions, 4,410 low Apgar scores, 204 neonatal deaths, and 126 cases of CP. However, there were 81,900 more cesarean deliveries. The strategy cost

Exercise for the Prevention of Preterm Birth: A Cost-Effectiveness Analysis [37D]

356 million more, but was cost‐effective with an ICER of

Gestational Age at Delivery in Preeclampsia with Severe Features Stratified by Race [20C]

9,881.5 per QALY. Sensitivity analysis revealed that the intervention would be cost‐effective up to a cesarean rate of 54%. 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 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.