دورية أكاديمية
Obstetric management for stillbirth complicated by a prior cesarean delivery: a cost-effectiveness analysis.
| العنوان: | Obstetric management for stillbirth complicated by a prior cesarean delivery: a cost-effectiveness analysis. |
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| المؤلفون: | Powell JM; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA., Hersh AR; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA., Greiner KS; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA., Frank ZC; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA., Pilliod RA; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA., Caughey AB; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA. |
| المصدر: | The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2022 Oct; Vol. 35 (19), pp. 3684-3693. Date of Electronic Publication: 2020 Oct 25. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Informa Healthcare Country of Publication: England NLM ID: 101136916 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-4954 (Electronic) Linking ISSN: 14764954 NLM ISO Abbreviation: J Matern Fetal Neonatal Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: London : Informa Healthcare Original Publication: Boca Raton : Parthenon Pub. Group, c2002- |
| مواضيع طبية MeSH: | Placenta Accreta* , Uterine Rupture*/epidemiology , Uterine Rupture*/etiology , Vaginal Birth after Cesarean*/adverse effects, Cost-Benefit Analysis ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Retrospective Studies ; Stillbirth/epidemiology ; Trial of Labor ; United States |
| مستخلص: | Background: The primary concern for a trial of labor after cesarean (TOLAC) is a uterine rupture leading to neonatal injury or mortality and maternal mortality. In individuals who have a term stillbirth, the neonatal concern is absent, yet repeat cesarean delivery remains common in this setting. Given the increased maternal risks from cesarean, it is important to evaluate obstetric management options in the population of women who have a term stillbirth and prior cesarean delivery (CD). Objectives: To examine the outcomes and costs of a TOLAC via induction of labor verses a repeat CD for cases of stillbirth occurring near term. Study Design: A decision-analytic model incorporating the current and a subsequent delivery using TreeAge software was designed to compare outcomes in women induced for a TOLAC to those undergoing repeat CD in the setting of stillbirth at 34-41 weeks' gestation. We used a theoretical cohort of 6000 women, the estimated annual number of women a prior cesarean who experience a stillbirth in the United States. Outcomes included quality-adjusted life years (QALY) for both modes of delivery with consideration of future pregnancy risks. Future pregnancy risks included uterine rupture, hysterectomy, placenta accreta, maternal death, neonatal death, and neonatal neurological deficits. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Results: In our theoretical cohort of 6000 women with a prior CD and current stillbirth, induction of labor resulted in 4836 fewer cesarean deliveries during stillbirth management, 1040 fewer cesarean deliveries in the subsequent pregnancy, and 14 fewer cases of placenta accreta in the subsequent pregnancy, despite 29 additional uterine ruptures across both pregnancies. Induction of labor was found to be the dominant strategy, resulting in decreased costs and increased QALYs. Univariate sensitivity analyses demonstrated that induction of labor was cost effective until the risk of uterine rupture in the first delivery exceeded 0.83% (baseline estimate: 0.38%). Additional univariate sensitivity analyses found that induction of labor was cost effective until the risk of IOL failure in the first delivery exceeded 64% (baseline estimate: 19%). Conclusion: In our theoretical cohort, induction of labor for TOLAC in the setting of a stillbirth with a history of prior CD is cost effective compared to a repeat CD. The results of this analysis demonstrate the benefit of induction of labor among women in this scenario who desire a future pregnancy. |
| فهرسة مساهمة: | Keywords: Cesarean delivery; cost-effectiveness analysis; induction of labor; stillbirth; trial of labor after cesarean; uterine rupture |
| تواريخ الأحداث: | Date Created: 20201026 Date Completed: 20220811 Latest Revision: 20220811 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1080/14767058.2020.1837770 |
| PMID: | 33103519 |
| قاعدة البيانات: | MEDLINE |
PDF full text from Publisher | تدمد: | 1476-4954 |
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| DOI: | 10.1080/14767058.2020.1837770 |