While antenatal corticosteroids (ACS) administered in the late preterm period have been shown to reduce respiratory morbidity, this finding was demonstrated in a well-designed randomized controlled trial (ALPS) with strict inclusion/exclusion criteria that may differ from clinical practice. The aim of this study was to investigate whether there has been indication creep since use of late preterm ACS became standard of care. Retrospective cohort study of pregnant women who received late preterm ACS between 2016 and 2019 were identified and separated into epochs of 2016-2017 and 2018-2019 based upon year of exposure. The primary outcome was rate of inappropriate ACS exposure, defined as non-adherence to the inclusion/exclusion criteria of the ALPS trial. Secondary outcomes were rates of non-optimal ACS exposure (delivery >7 days from ACS or term delivery). Logistic regression was used to generate adjusted odds ratios (aOR) between epochs for the primary outcome adjusting for confounders. There were 660 women who received late preterm ACS during the study period with 229 (34.6 %) deemed inappropriate exposures. The most common reason for inappropriate treatment was PPROM (29.0%) with exclusionary cervical exam or contraction frequency. No difference was observed in inappropriate ACS exposure between epochs (aOR 0.83, CI 0.59-1.2). However, there was a reduction in non-optimal exposure over time (aOR 0.67, 0.47-0.97) . Women receiving inappropriate ACS were more likely to deliver at term if indicated for maternal/fetal status (50.0% vs 19.5%; p<.001) and preterm labor (66.0% vs 41.9%; p=.015). Further, inappropriate exposure in PTL had higher rates of exposure latency >7 days (62.3% vs 39.1%; p=.006) with a longer latency to delivery (3 vs 16 days; p<.001). Over one third of women received late preterm ACS for an indication that could be classified as indication creep. Depending on indication, inappropriate administration is associated with higher rates of non-optimal exposure.

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pneumonic "IPASS-OB" designed to highlight essential patient information specific to labor and delivery patients. Paired t-test analysis was used to analyze resident scores before and after training in the pneumonic. RESULTS: 4 PGY-2 residents were evaluated during the study period. A total of 28 evaluations were completed by 3 unique attending observers. Post intervention scores were significantly higher in the three domains assessed by the survey: content (6.60 v. 4.79 pre intervention, p ¼ 0.022), clinical judgment (6.90 vs. 5.29, p ¼ 0.044) and overall performance (7.14 vs. 5.14, p ¼ 0.036) CONCLUSION: Resident training in an obstetric specific pneumonic has the potential to improve performance on a validated handoff evaluation tool. The model represents a readily available method to augment a critical component of medical care on the labor floor.