715 Cost-Effectiveness of external cephalic version for term breech presentation: a single center experience

Abstract

Breech presentation occurs in 3–4% of term pregnancies and is an indication for almost one-fifth of primary cesarean deliveries. External cephalic version(ECV) has been considered as an alternative to cesarean delivery for those who wish to undergo a trial of labor and have no contraindication to vaginal delivery. The objective of this study is to determine the effect of external cephalic version on the cesarean section rate and to calculate the cost savings associated with successful version It is a retrospective study of all women with a singleton pregnancy and non-cephalic presentation who had an attempted ECV at or after 36 weeks of gestation at a single tertiary center. After approval by our institutional IRB, Patients’ charts were reviewed from January 2012 to December 2017 Overall 372 women underwent ECV during the study period, of whom 324 were eligible for analysis. ECV was successful in 237(73.1 %) of the 324 attempted versions and unsuccessful in 87 (26.9%). Eighty-one percent of patients (n=193)who had successful versions were delivered vaginally and 19 % (n=44) by cesarean section. Of the 87 women with unsuccessful version, seven patients (7.8%) were noted to have cephalic presentation when they presented in labor and were delivered vaginally.The cesarean section rate was significantly lower in the patients who had successful ECV (n=44, 18.6%) compared to those who had failed ECV (n=80, 92%, P- < 0.001)(Fig 1 ). The resulting total number of vaginal deliveries (n = 200) allowed for a 34.6% savings in the total cost of these deliveries, and 96.5% of these savings were attributed to successful ECV. Overall, the average cost and cost savings of the study population were $4,366,096 and $2,228,764 respectively(Fig 2). No major fetal or maternal complications were observed. ECV significantly reduces the cesarean section rate and the cost associated with delivery in patients with breech presentation at term. It should be considered a safe alternative to the cesarean section for all the patients with breech presentation if there are no contraindicationsView Large Image Figure ViewerDownload Hi-res image Download (PPT)