281: Outcomes associated with tachysystole term laboring patients

ObjectiveTo investigate maternal and neonatal outcomes associated with tachysystole (TS).Study DesignRetrospective cohort study of term, laboring patients in a single health system over 26 months. TS defined by ACOG criteria (>5 UC in 10 min averaged over 30 min). Assessed outcomes after any TS, TS with change in FHR category (TS-F), TS necessitating intervention (TS-I, change oxytocin, terbutaline, oxygen), and TS leading to delivery (TS-D, cesarean or OVD within 30 minutes). Assessed outcomes by number of TS events. Subjects without any TS were the referent group and analyses controlled for oxytocin, misoprostol, multiparity, hypertension, marriage status and preeclampsia.ResultsWe evaluated a total of 50335 deliveries from 48529 women. A total of 6428 (12.4%) had at least one TS event, 3107 (6.2%) had a TS-F, 2179 (4.3%) had a TS-I, and 876 (1.7%) had a TS-D. These events were not mutually exclusive. 44087 (87.6%) of labors had no TS event, 4410 (8.8%) had 1 TS event, 1203 (2.3%) had 2 TS events, and 635 (1.3%) had 3+ TS events. Table 1 shows TS outcomes for each TS category. For each additional TS event the incremental RR for C-section was 1.03 (0.99-1.17), for operative vaginal delivery was 1.13(1.09-1.17), for NICU admission was 1.13 (1.08-1.18), and for neonatal sepsis was 1.22(1.12-1.34). The individual outcomes of intraventricular hemorrhage, necrotizing enterocolitis, pneumothorax, and low APGAR (<7 at 5 minutes) were not significantly associated with type or number of TS events. However, when neonatal morbidity was examined as a composite neonatal outcome (sepsis, IVH, NEC, pneumothorax, low Apgar), the relative risks were 1.26 (1.08-1.46) for TS, 1.47 (1.21-1.77) for TS with FHR changes, 1.31 (1.04-1.65) for TS necessitating intervention, and 1.10 (0.72-1.67) for TS leading to delivery within 30 minutes.Tabled 1ConclusionTS events increase the incidence of operative vaginal delivery and neonatal morbidity. TS events increase the risk of NICU admission and composite adverse neonatal outcome by about 30%. The influence of TS events on Cesarean delivery varies with type of event. ObjectiveTo investigate maternal and neonatal outcomes associated with tachysystole (TS). To investigate maternal and neonatal outcomes associated with tachysystole (TS). Study DesignRetrospective cohort study of term, laboring patients in a single health system over 26 months. TS defined by ACOG criteria (>5 UC in 10 min averaged over 30 min). Assessed outcomes after any TS, TS with change in FHR category (TS-F), TS necessitating intervention (TS-I, change oxytocin, terbutaline, oxygen), and TS leading to delivery (TS-D, cesarean or OVD within 30 minutes). Assessed outcomes by number of TS events. Subjects without any TS were the referent group and analyses controlled for oxytocin, misoprostol, multiparity, hypertension, marriage status and preeclampsia. Retrospective cohort study of term, laboring patients in a single health system over 26 months. TS defined by ACOG criteria (>5 UC in 10 min averaged over 30 min). Assessed outcomes after any TS, TS with change in FHR category (TS-F), TS necessitating intervention (TS-I, change oxytocin, terbutaline, oxygen), and TS leading to delivery (TS-D, cesarean or OVD within 30 minutes). Assessed outcomes by number of TS events. Subjects without any TS were the referent group and analyses controlled for oxytocin, misoprostol, multiparity, hypertension, marriage status and preeclampsia. ResultsWe evaluated a total of 50335 deliveries from 48529 women. A total of 6428 (12.4%) had at least one TS event, 3107 (6.2%) had a TS-F, 2179 (4.3%) had a TS-I, and 876 (1.7%) had a TS-D. These events were not mutually exclusive. 44087 (87.6%) of labors had no TS event, 4410 (8.8%) had 1 TS event, 1203 (2.3%) had 2 TS events, and 635 (1.3%) had 3+ TS events. Table 1 shows TS outcomes for each TS category. For each additional TS event the incremental RR for C-section was 1.03 (0.99-1.17), for operative vaginal delivery was 1.13(1.09-1.17), for NICU admission was 1.13 (1.08-1.18), and for neonatal sepsis was 1.22(1.12-1.34). The individual outcomes of intraventricular hemorrhage, necrotizing enterocolitis, pneumothorax, and low APGAR (<7 at 5 minutes) were not significantly associated with type or number of TS events. However, when neonatal morbidity was examined as a composite neonatal outcome (sepsis, IVH, NEC, pneumothorax, low Apgar), the relative risks were 1.26 (1.08-1.46) for TS, 1.47 (1.21-1.77) for TS with FHR changes, 1.31 (1.04-1.65) for TS necessitating intervention, and 1.10 (0.72-1.67) for TS leading to delivery within 30 minutes.Tabled 1 We evaluated a total of 50335 deliveries from 48529 women. A total of 6428 (12.4%) had at least one TS event, 3107 (6.2%) had a TS-F, 2179 (4.3%) had a TS-I, and 876 (1.7%) had a TS-D. These events were not mutually exclusive. 44087 (87.6%) of labors had no TS event, 4410 (8.8%) had 1 TS event, 1203 (2.3%) had 2 TS events, and 635 (1.3%) had 3+ TS events. Table 1 shows TS outcomes for each TS category. For each additional TS event the incremental RR for C-section was 1.03 (0.99-1.17), for operative vaginal delivery was 1.13(1.09-1.17), for NICU admission was 1.13 (1.08-1.18), and for neonatal sepsis was 1.22(1.12-1.34). The individual outcomes of intraventricular hemorrhage, necrotizing enterocolitis, pneumothorax, and low APGAR (<7 at 5 minutes) were not significantly associated with type or number of TS events. However, when neonatal morbidity was examined as a composite neonatal outcome (sepsis, IVH, NEC, pneumothorax, low Apgar), the relative risks were 1.26 (1.08-1.46) for TS, 1.47 (1.21-1.77) for TS with FHR changes, 1.31 (1.04-1.65) for TS necessitating intervention, and 1.10 (0.72-1.67) for TS leading to delivery within 30 minutes. ConclusionTS events increase the incidence of operative vaginal delivery and neonatal morbidity. TS events increase the risk of NICU admission and composite adverse neonatal outcome by about 30%. The influence of TS events on Cesarean delivery varies with type of event. TS events increase the incidence of operative vaginal delivery and neonatal morbidity. TS events increase the risk of NICU admission and composite adverse neonatal outcome by about 30%. The influence of TS events on Cesarean delivery varies with type of event.