Poster Session 2
Erik G. Holder, MD, MPH (he/him/his)
Resident Physician
University of Texas Health Science Center at San Antonio
San Antonio, Texas, United States
Patrick S. Ramsey, MD, MSPH
H. Frank Connally, Jr Professor in Obstetrics & Gynecology Chief, Division of MFM
University of Texas Health Science Center San Antonio
San Antonio, Texas, United States
Camille B. Marquez, RN
University Health System
San Antonio, Texas, United States
John J. Byrne, MD, MPH
Assistant Professor
University of Texas Health San Antonio
San Antonio, Texas, United States
Antenatal surveillance is recommended by the American College of Obstetricians despite the lack of published data proving a direct reduction in fetal mortality. We sought to evaluate the impact of a standardized antenatal fetal surveillance protocol on stillbirth rates at our level IV maternal care, safety-net hospital.
Our institution implemented an updated, heightened antepartum surveillance protocol based on the ACOG Committee Opinion #828 in March of 2023. A retrospective cohort study was performed reviewing stillbirths one year pre- and one year post-implementation of the protocol. Cases involving known, life-limiting or lethal fetal anomalies, multi-fetal gestations, and complete absence of prenatal care in the hospital system were excluded from the analysis. Stillbirth was defined as fetal death occurring between 20 0/7 weeks gestation until delivery. Secondary outcomes evaluated neonatal intensive care unit (NICU) admission rates, APGAR scores, and induction rates. Inductions were stratified into late preterm, early term, term, and late-term groups. Chi-square and Fisher’s exact test were used for comparisons as appropriate to compare rates between cohorts.
A total of 4078 deliveries occurred pre-implementation (3/10/2022 – 3/10/2023) with 18 stillbirths identified (0.4%). A total of 4985 deliveries occurred post-implementation (06/10/2023 – 06/10/2024), with 19 stillbirths identified (0.4%). Overall stillbirth rates did not change despite protocol implementation (p=0.74), nor when evaluated by gestational age time epoch (p >0.05). Rates of induction, however, were significantly decreased for early term and term pregnancies (p=0.02, p=0.02, respectively) in the post-implementation period. NICU admission rates and APGAR scores were not noted to have significant difference across groups.
Our data suggests that increased surveillance does not significantly impact stillbirth rates at our institution but does decrease incidence of early term and term inductions without adverse impact on NICU admission rates or APGAR scores.
