Quality Improvement Reduces Nulliparous, Term, Singleton, Vertex Cesarean Rates Without Increasing Neonatal Morbidity [ID 917]

INTRODUCTION: Reducing rates of nulliparous, term, singleton, vertex (NTSV) cesarean deliveries (CDs) has been identified as a quality target by several national governmental and medical organizations. In response to these initiatives, our hospital reduced our NTSV CD rate in 2023 through a quality improvement (QI) project. The objective of this study is to determine if a lower NTSV CD rate is associated with increased adverse neonatal morbidity or mortality. METHODS: This is a retrospective cohort study of all patients with NTSV deliveries who gave birth in 2022 (pre-intervention) and 2023 (post-intervention). Quality improvement education sessions were performed monthly from January 2023 through December 2023. Patients were identified through an electronic health record using a hospital-created obstetrical database with neonatal and maternal outcomes. Statistical analysis was performed using chi-squared tests in SAS. RESULTS: A total of 1,545 patients with NTSV deliveries were included in this study: 725 in 2022 (pre-intervention) and 820 in 2023 (post-intervention). The rate of NTSV CD significantly decreased between 2022 and 2023 (27% versus 22.3%; P =.03). Rates of neonatal APGARs less than 7 (0.41% versus 0.37%; P =.87), neonatal loss (0.14% versus 0%; P =.28), and overall composite unexpected complications in term newborns (PC06 [5.1% versus 4.5%; P =.58]) were not significantly different between study groups. CONCLUSIONS/IMPLICATIONS: Our study demonstrated that implementing a monthly QI session successfully led to a significant reduction in the NTSV cesarean birth rate, without any associated increase in adverse neonatal outcomes. These findings support ongoing national efforts to lower NTSV cesarean rates, prevent unnecessary CD, and improve maternal morbidity and mortality.