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  1. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound.

    Article - En anglais

    Objective

    - To quantitate the potential effectiveness and monetary costs of a policy of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound.

    Design

    - A decision analytic model was constructed to compare 3 policies :

    • (1) management without ultrasound ;

    • (2) ultrasound and elective cesarean delivery for estimated fetal weight of 4000 g or more (4000-g policy) ;

    • and (3) ultrasound and elective cesarean delivery for estimated fetal weight of 4500 g or more (4500-g policy).

    The impact of matemal diabetes was analyzed separately.

    Probability data used in the decision analytic model were summarized from the literature and supplemented with unpublished data from the Collaborative Trial of Preterm Birth Prevention.

    Costs were estimated from the literature, regional reimbursements, and clinical practice data.

    Main Outcome Measures

    - Rates of shoulder dystocia and permanent brachial plexus injury, and both the number of additional cesarean births and monetary costs per permanent brachial plexus injury averted.

    Results

    - In the baseline analysis for nondiabetic women, the ultrasound policies increased both the cesarean delivery rate and costs, while decreasing the rate of shoulder dystocia and brachial plexus injury.

    For each permanent brachial plexus injury prevented by the 4500-g policy, 3695 cesarean deliveries were performed at an additional cost of $8.7 million, vs 2345 cesarean deliveries and $4.9 million with the 4000-g policy. (...)

    Mots-clés Pascal : Macrosomie, Césarienne, Accouchement provoqué, Echographie, Diagnostic, Economie santé, Analyse coût efficacité, Homme, Femelle, Malformation, Gestation pathologie, Foetus pathologie, Chirurgie, Exploration ultrason

    Mots-clés Pascal anglais : Macrosomia, Cesarean section, Induced delivery, Echography, Diagnosis, Health economy, Cost efficiency analysis, Human, Female, Malformation, Pregnancy disorders, Fetal diseases, Surgery, Sonography

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0044158

    Code Inist : 002B20G02. Création : 21/05/1997.