Coming out ahead: the cost effectiveness of external cephalic version using spinal anesthesia

James A O’Brien,Eli Y Adashi

doi:10.1186/2045-4015-3-6

Abstract

Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades. External cephalic version (ECV) is recommended at term by most professional organizations in an effort to reduce the prospect of cesarean deliveries. The authors propose the use of regional anesthesia to increase efficacy and reduce cost in the care of patients who undergo ECV in an effort to convert a breech presentation to a vertex counterpart. Despite emerging evidence of the advantages, obstacles to more comprehensive implementation of this approach continue to exist, which include patient acceptance, provider experience, and safety concerns. The addition of tocolytics and use of regional anesthesia for secondary ECV efforts have also been considered as options to increase success and reduce cost. This is a commentary on http://www.ijhpr.org/content/3/1/5.

Highlights

Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades
In an effort to decrease the incidence of cesarean deliveries for breech presentation, professional organizations recommend offering most patients external cephalic version (ECV) at term
* Correspondence: jobrien@wihri.org 1Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA Full list of author information is available at the end of the article renewed interest in this technique, considerable research has been devoted to interventions that will improve the success and the patient acceptance of External cephalic version (ECV). In addition to these efforts to reduce the overall incidence of cesarean deliveries and their inherent morbidities, it is essential to assess the cost of the relevant interventions to the healthcare system. In this month’s issue of the Israel Journal of Health Policy Research, Weiniger and colleagues evaluate the hospital costs associated with alternative clinical approaches to breech presentation [5]

Summary

Introduction

Breech presentation is encountered in 3 to 4% of term pregnancies and has been a significant driver of the increased rate of cesarean deliveries over the last 4 decades. In an effort to decrease the incidence of cesarean deliveries for breech presentation, professional organizations recommend offering most patients external cephalic version (ECV) at term. In this secondary analysis of data from two prior studies (by applying adjusted cost data), the authors conclude that external cephalic version under neuraxial blockade is a cost-effective approach to the challenges presented by the breech presentation.

Results

Conclusion