Poster Session III Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues www.AJOG.org

thinking and target fixation scored above average (median 6 (IQR2-8)). ABC-evaluation (CGR) was seldom applied (median 2 (IQR1-5)). The teams scored remarkably well on all leadership-skills.There was a strong correlation between team communication andleadership (r2 0,74, p < 0,05). No correlation was found betweenteam communication and the amount of blood loss (r2 0,04, p ¼0,76) (fig).CONCLUSION: Non-technical skills of the Dutch obstetric teams inthe management of PPH are moderate, with a lowest score onstructured information transfer and highest on leadership. ABC-evaluation is not integrated in the obstetric emergency care routine.Improving team performance by up scaling NTS through skills-training may be an important part of the overall strategy to improvePPH-care.

S218 American Journal of Obstetrics & Gynecology Supplement to JANUARY

Results of the obstetric teams’ ’nontechnical skills’(CTS and CGR)

431 Quality of care in women with a major obstetric

hemorrhage before, during and after labor in a tertiary carehospital in the Netherlands; a patients’ perspectiveSuzan de Visser1, Christian Kirchner1, Jeroen van Dillen1,Rosella Hermens2, Mallory Woiski11Radboud University Nijmegen Medical Centre, Obstetrics & Gynaecology,Nijmegen, Netherlands, 2Radboud University Nijmegen Medical Centre, IQHealthcare, Nijmegen, Netherlands

OBJECTIVE: Major obstetric hemorrhage (MOH) is one of the maincauses of maternal morbidity with a great impact on the patient andher family. Major hemorrhage, classified by the ATLS classificationfor hypovolemic shock, is a loss of more than 40% of the circulatingvolume (� 2500 ml in a pregnant woman). We evaluated the carereceived before, during and after the MOH from the patients’perspective.STUDY DESIGN: Women having delivered between 2008 and 2012 inthe Radboud University Nijmegen with a MOH or referred becauseof a postpartum hemorrhage were included. A questionnaire wasdeveloped based on international literature, patient interviews, andclinical experience. It comprised of 40 multiple-choice questions,divided among 4 sections: patient satisfaction, care after the delivery,long-term consequences and an open comment section.RESULTS: In total 95 questionnaires were filled in (67% responserate). Most patients were satisfied with the overall care. However,when looking closely only 8 of the 62 items on patient satisfaction(fig), had a minimum of 75% score for appropriate care received.The main issue was inadequate information supply, an item alsorecurring in the open comment section (42% made an additionalremark). 14% commented about a lack of attention and commu-nication to the partner. The complaints women were having weremainly of a psychological nature. 89% of the patients had at least onecomplaint, 2/3rd lasting for more than 3 months. 35% of the womenwould have preferred an additional appointment for professionalguidance.CONCLUSION: Women who experienced a MOH find the care theyreceived insufficient especially regarding information for her and herpartner. More than half of the patients have long lasting complaints,and more professional guidance is wanted. The current care after theMOH is deficient. MOH is a major life event for most women and

2014

www.AJOG.org Epidemiology, Ob Quality, Operative Obstetrics, Public Health, Infectious Disease, Academic Issues Poster Session III

their partners and specific postpartum clinical and after care isindicated.

Overview of the items scored on patient satisfactionof the received care

432

A cost-effective analysis of non-invasive prenataltesting for trisomy 21 in low-risk womenJennifer Durst1, Amelia Sutton1, Lorie Harper1, Joseph Biggio11University of Alabama at Birmingham, Department of Obstetrics andGynecology, Division of Maternal Fetal Medicine, Birmingham, AL

OBJECTIVE: Non-invasive prenatal testing (NIPT) has been validatedas a highly sensitive and specific screening test in women at high riskfor fetal aneuploidy. Prior to this innovation, prenatal testing waslimited to either invasive techniques or screening with serummarkers and ultrasound. Despite its superior performance, NIPTremains a costly option that has not been sufficiently evaluated as aprimary screening tool in low-risk women. We sought to determinethe most cost-effective screening strategy for trisomy 21 (T21) inlow-risk (< 35 years of age) women.STUDY DESIGN: A decision analytic model compared 6 screeningstrategies for T21 in low-risk women (Table). Probabilities and costswere derived from the literature and local data. We assumed that50% of women with positive screening tests proceeded with either

Supplem

NIPTor an invasive test and that all women with positive NIPTs hadan invasive test. The NIPT cost point estimate represented the mostcommonly used and most expensive platform. Outcomes includednumber of T21 diagnoses, procedure-related euploid losses, T21livebirths, and cost per diagnosis (not including lifetime cost ofcare). Multivariable sensitivity analyses were performed to test thestability of the model with varying estimates.RESULTS: In a theoretical cohort of 10,000 women, NIPT identifiedequal numbers of T21 cases as invasive testing but had the lowestrate of euploid loss. However, NIPT was one of the least cost-effective paradigms with an incremental cost effectiveness ratio(ICER) of $1,160,746. Multivariable sensitivity analysis showed thatNIPT was preferred most frequently of the prenatal testing options.CONCLUSION: In this model, NIPT was one of the least cost-effectiveT21 screening modalities. However, with varying point estimates,NIPT was the preferred strategy of all prenatal screening paradigms.As NIPT becomes more affordable and if its performance is validatedin low-risk women, it will likely evolve into a more cost-effectivescreening strategy in low-risk women.

Cost analysis of NIPT compared to other screeningstrategies for T21 in low-risk women

433

Obstetrical complications of deliveries conceived byassisted reproductive technology in CaliforniaAlex Fong1, Sarah Lovell1, Steve Rad2, Aaron Turner2, Deyu Pan3,Dotun Ogunyemi41University of California, Irvine, Obstetrics and Gynecology, Orange, CA,2Cedars-Sinai Medical Center, Obstetrics and Gynecology, Los Angeles, CA,3Charles Drew University of Medicine and Science, Center for Health ServicesResearch, Los Angeles, CA, 4David Geffen School of Medicine, Obstetrics andGynecology, Los Angeles, CA

OBJECTIVE: To describe the characteristics of subjects who deliveredin California in 2009 and had pregnancies identified as beingconceived by assisted reproductive technology (ART) via ICD-9code.STUDY DESIGN: A case control study was performed on 551 subjectswho underwent ART and subsequently delivered in California. De-liveries were extracted by ICD-9 code. The comparator group was allremaining deliveries not including the code for ART (n¼406,885).Comparisons between the two groups were made using chi-squareanalysis. A logistic regression analysis was performed which adjustedfor the following demographic and medical confounders: age, race/ethnicity, insurance type, year of delivery, chronic hypertension,diabetes, obesity, thyroid disease, and multiple gestations.RESULTS: Pregnancies which were conceived via ART had higherassociations with antepartum conditions such as urinary tractinfection (OR 1.71, 95% CI 1.01-2.90), placenta previa (OR 1.77,95% CI 1.10-2.85), placental abruption (OR 2.43, 95% CI

ent to JANUARY 2014 American Journal of Obstetrics & Gynecology S219