| Elective cesarean section to prevent anal incontinence and brachial plexus injuries associated with macrosomia--a decision analysis. | |
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MedLine Citation:
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PMID: 15647962 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Our aim was to determine the cost-effectiveness of a policy of elective C-section for macrosomic infants to prevent maternal anal incontinence, urinary incontinence, and newborn brachial plexus injuries. We used a decision analytic model to compare the standard of care with a policy whereby all primigravid patients in the United States would undergo an ultrasound at 39 weeks gestation, followed by an elective C-section for any fetus estimated at > or =4500 g. The following clinical consequences were considered crucial to the analysis: brachial plexus injury to the newborn; maternal anal and urinary incontinence; emergency hysterectomy; hemorrhage requiring blood transfusion; and maternal mortality. Our outcome measures included (1) number of brachial plexus injuries or cases of incontinence averted, (2) incremental monetary cost per 100,000 deliveries, (3) expected quality of life of the mother and her child, and (4) "quality-adjusted life years" (QALY) associated with the two policies. For every 100,000 deliveries, the policy of elective C-section resulted in 16.6 fewer permanent brachial plexus injuries, 185.7 fewer cases of anal incontinence, and cost savings of $3,211,000. Therefore, this policy would prevent one case of anal incontinence for every 539 elective C-sections performed. The expected quality of life associated with the elective C-section policy was also greater (quality of life score 0.923 vs 0.917 on a scale from 0.0 to 1.0 and 53.6 QALY vs 53.2). A policy whereby primigravid patients in the United States have a 39 week ultrasound-estimated fetal weight followed by C-section for any fetuses > or =4500 g appears cost effective. However, the monetary costs in our analysis were sensitive to the probability estimates of urinary incontinence following C-section and vaginal delivery and the cost estimates for urinary incontinence, vaginal delivery, and C-section. |
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Authors:
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Patrick J Culligan; John A Myers; Roger P Goldberg; Linda Blackwell; Stephan F Gohmann; Troy D Abell |
Publication Detail:
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Type: Journal Article Date: 2004-07-29 |
Journal Detail:
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Title: International urogynecology journal and pelvic floor dysfunction Volume: 16 ISSN: - ISO Abbreviation: Int Urogynecol J Pelvic Floor Dysfunct Publication Date: 2005 Jan-Feb |
Date Detail:
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Created Date: 2005-01-13 Completed Date: 2005-05-10 Revised Date: 2011-08-18 |
Medline Journal Info:
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Nlm Unique ID: 9514583 Medline TA: Int Urogynecol J Pelvic Floor Dysfunct Country: England |
Other Details:
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Languages: eng Pagination: 19-28; discussion 28 Citation Subset: IM |
Affiliation:
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Department of Obstetrics, Gynecology and Women's Health, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Louisville Health Sciences Center, 315 East Broadway M-18, Louisville, KY 40202, USA. culligan@mybladderMD.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Birth Weight Brachial Plexus Neuropathies / etiology*, prevention & control* Cesarean Section / economics*, utilization* Cost Savings Cost-Benefit Analysis Decision Trees* Fecal Incontinence / economics, etiology*, prevention & control* Female Fetal Macrosomia* Health Policy Humans Pregnancy Quality of Life Surgical Procedures, Elective* Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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