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P046Impact of birthing volumes on abortion provision and surgical miscarriage management

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      Objectives

      Pregnancy is a condition with a finite number of outcomes, including birth, abortion, and pregnancy loss. Existing studies describe seasonality trends for birth and abortion, but no studies assess relationships between birthing volumes and surgical abortion or surgically managed early pregnancy loss (SEPL) volumes. To evaluate relationships between obstetric outcomes, we designed this retrospective review of birth, abortion, and SEPL volumes at our medical center.

      Methods

      This retrospective ecological study utilized CPT billing codes to detail birth, abortion, and SEPL  volumes at Vanderbilt University Medical Center from 2011 to 2019. Abortion and miscarriage cases were validated by individual chart review by the study team. Data were plotted on line and bar graphs to evaluate changes over time and relationships between outcomes.

      Results

      A total of 50,472 obstetric outcomes occurred in the study period. Proportions of White and Black patients were similar in the birth and composite abortion SEPL outcomes (68.2% vs. 71.6%; 15.5% vs. 17.4%). Both birth and surgical abortion volumes per year essentially doubled (3,511 to 6,573, 13–29); SEPL volume increased by a factor of 2.6 (115–268). The proportions of abortions and SEPL outcomes remained constant throughout the study period (0.4% and 3.4%).

      Conclusions

      As birthing volumes increase, so do abortion and SEPL volumes. Outcome proportions remained stable over time; these proportions can be used to estimate future abortion and SEPL volumes based on anticipated delivery volumes. When increasing delivery volumes, medical centers must prepare for increases in patients experiencing the breadth of obstetric outcomes.
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