(606) Implementation of a standardized protocol for labor induction: impact on obstetric disparities

Objective: Prior retrospective data demonstrated that standardization of labor induction (IOL) may reduce racial disparities in cesarean delivery (CD) and morbidity. Here, we aimed to determine the impact of prospectively implementing an IOL protocol on racially disparate outcomes.

Study Design: This was a prespecified secondary analysis of a type I hybrid effectiveness-implementation trial comparing 2 years before (PRE) and 2 years after (POST) implementation of a standardized IOL protocol at 2 sites (2018-2022). The protocol had 8 components and recommended active IOL management, frequent cervical exams, and amniotomy by first exam ≥4cm. All singletons ≥37 weeks with intact membranes requiring cervical ripening were eligible; prior CD was excluded. This analysis included only those with self-recorded race, divided into Black, Indigenous, People of Color (BIPOC) and non-BIPOC. Poisson regression with interaction terms evaluated the protocol’s impact on disparities in CD and morbidity. Fidelity to the protocol was defined as adherence to ≥75% of the 8 protocol components.

Results: 8386 were included (PRE=4167; POST=4219); 59.3% identified as BIPOC. BIPOC patients differed in delivery site, insurance, BMI, parity, maternal age, diagnosis of diabetes and hypertension, gestational age, and IOL indication, included as confounders. BIPOC patients were more likely to undergo CD in both PRE (aRR 1.36[1.18-1.58]) and POST (aRR 1.55[1.33-1.70]) groups, even when controlling for these differences. Adjusted relative risk of maternal morbidity was greater among BIPOC patients both PRE (aRR 1.25[1.07-1.46]) and POST (aRR 1.34[1.14-1.58]). There was no difference by race in neonatal morbidity in either PRE or POST. There was no differential effect of the protocol by race on CD or morbidity (Table). Protocol fidelity increased PRE to POST for both BIPOC (58.4% to 64.3%, p< 0.001) and non-BIPOC patients (43.6% to 53.1%, p< 0.001; interaction p=0.15).

Conclusion: Despite increased utilization of a standardized IOL protocol across races, this intervention did not mitigate observed racial disparities in CD or maternal morbidity.