Cost-effectiveness of external cephalic version for term breech presentation

<p>Abstract</p> <p>Background</p> <p>External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation.</p> <p>Methods</p> <p>A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and$5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness.</p> <p>Results</p> <p>The incremental cost-effectiveness of ECV, assuming a baseline 58$7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean.</p> <p>Conclusions</p> <p>From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.</p

Placenta accreta and the developing world - A review

Background: The rising Caesarean section rate in the developing world implies that the incidence of placenta accreta might be on the increase and this might worsen the maternal mortality burden.Objective: To draw the attention of Obstetricians and other relevant professionals to this emerging but challenging trend.Data Sources: Original research findings and reviews published in the English literature. Additional information was obtained from texts and electronic books such as CD ROMS.Data Extraction: Online searches of electronic database (Medline, Pubmed and Embase), requests for reprints from corresponding authors and institutional/private subscriptions.Data Synthesis: Information obtained was categorised accordingly.Conclusion: Optimal treatment of women with placenta accreta requires recognition of the clinical risk factors, accurate pre-operative diagnosis and meticulous planning to ensure safety at the time of delivery. In view of the rising incidence of this condition, and the absence of a highly reliable antenatal diagnostic method especially in developing countries, a high index of suspicion and advanced preparation is required to reduce its associated maternal morbidity and mortality

Partial Androgen Insensitivity Syndrome: A Case Report

No Abstract Available J. Expt. & Clin. Anat Vol.3(1) 2004:45-4

Prevalence of Rhesus Negative Gene and Awareness of its Implications

To determine the prevalence of the Rhesus negative gene in pregnant women attending antenatal clinics at Abia State University Teaching Hospital, Aba and to assess the awareness of women to any implications of their blood group, a retrospective study of 1200 women was carried out and a prospective study of 100 women randomly selected from same population at follow up visits to ascertain their awareness of the implication of their Rhesus status. The prevalence of the Rhesus negative gene was 7.5%. Only 5% were aware of the implications of Rhesus status. The prevalence is comparable with previous reports, the use of anti-D immunoglobulin is advised when appropriate. Key Words: Rhesus negative, genotype anti-D immunoglobulin. Jnl of Medical Investigation and Practice Vol.2 2001: 11-1

Vaginal misoprostol for induction of labour in women with intrauterine fetal death at Aba, South-Eastern Nigeria

No Abstract

Aetiological Factors in Female Infertility: The ABSUTH Experience

To determine the prevalence of infertility in a traditional Ibo society using Abia State University Teaching Hospital Aba as a case study and to identify the common causes of female infertility in Aba, a retrospective study of patient investigated and treated for infertility from 1st January to 31st December 1996 was done. A total of 1487 patients attended the gynaecological clinic of ABSUTH within the study period. Three hundred and thirty-five (22.5%) presented with infertility. Primary infertility occurred in 28.3% while secondary infertility occurred in (71.7%). The peak incidence of infertility was in the age group of 25 to 29 years. The major factors in female's infertility were: male factors 195 (58.2%), tubal factors 103 (30.6%) and ovarian factors 80 (23.8%). Twelve per cent of the patients had more than one factors operative. Infertility is a major gyanecological problem in Igbo society. Sexually transmitted disease injuries and infections sustained during abortion and labour may have a significant influence on the high level of infertility found in our analysis. Key Words: Female infertility, Igbo society, Aetiology and Prevention. Jnl of Medical Investigation and Practice Vol.2 2001: 46-4