Document Detail

Is vaginal birth after cesarean less expensive than repeat cesarean delivery?
MedLine Citation:
PMID:  10739514     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study was undertaken to compare total medical costs of trial of labor after cesarean with those of elective repeat cesarean without labor, with both short- and long-term neonatal costs associated with such procedures taken into account. STUDY DESIGN: Costs associated with All Patient Refined diagnosis-related groups and Current Procedural Terminology for a large not-for-profit health care system were applied to an algorithm describing maternal and neonatal outcomes of trial of labor. Perinatal morbidity rates and cost estimates for long-term neurologic damage associated with uterine rupture were derived from published literature. RESULTS: If a 70% vaginal birth rate for women undergoing a trial of labor and delivery in a tertiary center with a mean uterine rupture to delivery time of 13 minutes is assumed, the net cost differential ranged from a saving of $149 to a loss of $217, depending on morbidity assumptions. For vaginal birth after cesarean success rates <70%, trial of labor in the presence of two previous scars, and institutional factors increasing the perinatal morbidity rate by just 4% with respect to that seen in tertiary centers, trial of labor resulted in a net financial loss to the health care system regardless of all other assumptions made. CONCLUSIONS: When costs as opposed to charges are considered and the cost of long-term care for neurologically injured infants is taken into account, trial of labor after previous cesarean is unlikely to be associated with a significant cost saving for the health care system. Recent government-mandated length-of-stay requirements are likely to make the economic benefit of vaginal birth after cesarean even less favorable. Factors other than cost must govern decisions regarding trial of labor or repeat cesarean.
S L Clark; J R Scott; T F Porter; D A Schlappy; V McClellan; D A Burton
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  182     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2000 Mar 
Date Detail:
Created Date:  2000-05-02     Completed Date:  2000-05-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  599-602     Citation Subset:  AIM; IM    
Intermountain Health Care, University of Utah, Salt Lake City, Utah, USA.
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MeSH Terms
Birth Injuries / economics
Cesarean Section / economics*
Health Care Costs
Infant, Newborn
Risk Assessment
Time Factors
Trial of Labor
Vaginal Birth after Cesarean / economics*
Comment In:
Am J Obstet Gynecol. 2001 Jan;184(2):250-1   [PMID:  11174527 ]
Am J Obstet Gynecol. 2001 Mar;184(4):780   [PMID:  11262495 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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