Implementation of the ALPs Trial Into the Clinical Setting [36K]

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Abstract

INTRODUCTION:

With the advent of the antenatal late preterm steroids trial (ALPS), clinical practice patterns have changed. We sought to determine our hospital's rate of adherence to the ALPS protocol in the first year since its implementation.

METHODS:

This is a retrospective cohort study of all late preterm, singleton deliveries in our academic, tertiary care facility from March 1, 2016 to February 28, 2017. Exclusions included aneuploidy and major fetal anomalies. The primary outcome was the appropriate implementation of ALPS, including the identification of ineligible patients. Patients were divided based on delivery in the first or second half of the year. Secondary outcomes included maternal and neonatal outcomes. Data was analyzed as intention-to-treat. Student's t-test, χ2, and univariable logistic regression were utilized for analysis.

RESULTS:

Four hundred seven women with singleton pregnancies delivered in the late preterm period, and 393 were eligible for analysis. No significant differences were noted in demographic or clinical characteristics, including race, parity, admitting service, delivery indication, delivery mode, or birth weight between women who delivered in the first or second half of the year (all P>.05). In the year following adoption of ALPs, there was a significant improvement in the identification and implementation of the protocol (61.8% versus 79.2%, P<.01). There was a trend towards improved neonatal outcomes. However, likely due to the small sample size, it did not reach statistical significance.

CONCLUSION:

Implementation of ALPS improved over the first year following its adoption in our institution. However, 1 in 5 women were inappropriately managed. A strategy for increasing adherence to the ALPS protocol is needed.

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