Background
Methods
Structured review - search strategy
Identification of care pathways for women immediately following a stillbirth
Determining care pathways and patient numbers for pregnancy following a stillbirth
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Group 1 - Healthy multiparous women who had an uncomplicated pregnancy (‘normal’ women) [21]
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Group 2 - High-risk multiparous women with a previous healthy child◦ Group 2a - ‘Diabetic’ women [23]◦ Group 2b - ‘Hypertensive’ women [22]
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Group 3 - Multiparous women with a previous stillbirth◦ Group 3a - Women with known non-recurrent causes (e.g. parvovirus, isolated structural fetal anomaly, umbilical cord accident which are unlikely to recur in a subsequent pregnancy)◦ Group 3b - Women with known recurrent causes (e.g. fetal growth restriction which are known to recur in subsequent pregnancies)◦ Group 3c - Women with unknown causes
Resource use | Unit costs in £s in 2009/2010 prices | Source | ||
---|---|---|---|---|
Average | Lower quartile | Upper quartile | ||
Pre-conception care
| ||||
GP visit (clinic consultation lasting 17.2 minutes) | £53 | n/a | n/a | 22 |
Physician visit (consultation lasting 25 minutes) | £45 | n/a | n/a | 22 |
Consultant led multiprofessional consultation (first attendance) | £179 | £153 | £205 | 21 |
Consultant led multiprofessional consultation (follow-up attendance) | £134 | £111 | £140 | 21 |
Antenatal care
| ||||
Midwife appointment (lasting 20 minutes) | £23 | n/a | n/a | 22 |
Antenatal attendances
| ||||
Consultant led consultant consultation (first attendance) | £150 | 398 | £183 | 21 |
Consultant led consultant consultation (follow-up attendance) | £96 | £62 | £114 | 21 |
Consultant led consultant multiprofessional consultation (follow-up attendance) | £134 | £111 | £140 | 21 |
Consultant led midwife consultation (first attendance) | £77 | £51 | £86 | 21 |
Consultant led midwife consultation (follow-up attendance) | £51 | £32 | £58 | 21 |
Consultant led midwife multiprofessional consultation (first attendance) | £72 | £72 | £72 | 21 |
Consultant led midwife multiprofessional consultation (follow-up attendance) | £51 | £51 | £51 | 21 |
Outpatient procedure: antenatal investigation | £127 | £88 | £151 | 21 |
Antenatal ultrasounds
| ||||
Non-consultant led antenatal ultrasound (first attendance) | £63 | £45 | £87 | 21 |
Non-consultant led antenatal ultrasound (follow-up attendance) | £52 | £40 | £58 | 21 |
Delivery care (Elective episodes)
| ||||
Normal delivery with CC | £1,558 | £893 | £2,037 | 21 |
Normal delivery without CC | £1,151 | £433 | £1,644* | 21 |
Assisted delivery without CC | £1,374 | £1,167 | £1,872* | 21 |
Planned lower uterine caesarean section | £1,822 | £1,276 | £1,985 | 21 |
Emergency or upper uterine caesarean section | £2,979 | £2,915 | £3,463 | 21 |
Results
Structured literature review
Overview of the results
Further details of the relevant studies
Costs of investigation and care following a stillbirth
Resource type | Cost | Reference |
---|---|---|
Core investigations and counselling
| ||
Bereavement counselling* | £521 | |
Autopsy/post-mortem | £650 | University of Manchester Hospital Laboratory |
Placental pathology | £54 | University of Manchester Hospital Laboratory |
Kleihauer test | £17 | University of Manchester Hospital Laboratory |
Total core investigations
|
£1,242
| |
Other investigations (depending on clinical scenarios)
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Cytogenetics | £246 | University of Manchester Hospital Laboratory |
Thrombophilia screen | £132 | University of Manchester Hospital Laboratory |
- Prothrombin gene variant, Factor V Leiden mutation, Antithrombin III, Protein C, Protein S, Lupus anticoagulant, anticardiolipin antibodies.
| ||
Pre-eclampsia | £20 | University of Manchester Hospital Laboratory |
- Urea and electrolytes, liver function tests, serum urate.
| ||
HbA1c | £6 | University of Manchester Hospital Laboratory |
Haematology | £24 | University of Manchester Hospital Laboratory |
- Full blood count, DIC screen
| ||
Immunology | £9 | University of Manchester Hospital Laboratory |
Biochemistry | £28 | University of Manchester Hospital Laboratory |
- Bile acids, thyroid function tests, C-reactive protein.
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Microbiology | £55 | University of Manchester Hospital Laboratory |
- Blood cultures, mid-stream urine, vaginal swabs, cervical swabs.
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Serology | £42 | University of Manchester Hospital Laboratory |
- Parvovirus B19, rubella (if nonimmune at booking), CMV, herpes simplex and Toxoplasma gondii
| ||
Total cost for all tests
|
£1,804
|
Antenatal and delivery care costs in a subsequent pregnancy
Group | Pre-conception care costs | Total antenatal attendances | Ultrasound scans | Antenatal care | Total care (including antenatal and delivery care) | |||
---|---|---|---|---|---|---|---|---|
Women who deliver premature (<37 weeks gestation) | Women who deliver to full term (37 to 40 weeks gestation) | Women who deliver premature (<37 weeks gestation) | Women who deliver to full term (37 to 40 weeks gestation) | Women who deliver premature (<37 weeks gestation) | Women who deliver to full term (37 to 40 weeks gestation) | |||
1: Women with a previous healthy child | ✗ | 8 | 9 | 2 | 2 | £673 | £724 | £2,147 |
2a: Women with a previous healthy child but has diabetes | £500 | 11 | 13 | 5 | 5 | £1,309 | £1,411 | £3,870 |
2b: Women with a previous healthy child but has hypertension | £188 | 10 | 12 | 5 | 5 | £1,154 | £1,256 | £2,920 |
3a: Women with a previous stillbirth – known causes (non-recurrent) | £159 | 10 | 12 | 3 | 3 | £1,294 | £1,486 | £3,235 |
3b: Women with a previous stillbirth – known causes (recurrent)#
| £159 | 13 | 15 | 5 | 5 | £1,779 | £1,970 | £3,720 |
3c: Women with a previous stillbirth – unknown causes#
| £159 | 13 | 15 | 5 | 5 | £1,810 | £2,002 | £3,751 |
Group | Normal without complications | Normal with complications | Assisted delivery | Caesarean section (emergency) | Caesarean section (elective) | Source |
---|---|---|---|---|---|---|
1: Women with a previous healthy child | 0.670 | 0.000 | 0.110 | 0.130 | 0.090 | 43 |
2a: Women with a previous healthy child but has diabetes | 0.244 | 0.005 | 0.077 | 0.376 | 0.298 | 43 |
2b: Women with a previous healthy child but has hypertension | 0.559 | 0.050 | 0.155 | 0.132 | 0.104 | 43-44 |
3: Women with a previous stillbirth | 0.536 | 0.000 | 0.132 | 0.137 | 0.195 | 45 |
Group | Average unit costs | Best case scenario (using lower quartile costs) | Worst case scenario (using upper quartile costs) | ||||||
---|---|---|---|---|---|---|---|---|---|
Total costs of pregnancy | Mean cost per pregnant woman | Total costs of pregnancy | Mean cost per pregnant woman | Total costs of pregnancy | Mean cost per pregnant woman | ||||
Number | % | Number | % | Number | % | ||||
1: Women with a previous healthy child | £812,436,000 | 87.4 | £2,147 | £498,068,000 | 84.6 | £1,316 | £962,903,000 | 87.6 | £2,544 |
2a: Women with a previous healthy child but has diabetes | £80,470,000 | 8.7 | £3,870 | £65,128,000 | 11.1 | £3,132 | £92,229,000 | 8.4 | £4,436 |
2b: Women with a previous healthy child but has hypertension | £36,430,000 | 3.9 | £2,920 | £25,850,000 | 4.4 | £2,072 | £43,927,000 | 4.0 | £3,521 |
Total
|
£929,336,000
|
98.4
|
-
|
£589,046,000
|
98.2
|
-
|
£1,099,059,000
|
98.4
|
-
|
3a: Women with a previous stillbirth – known causes (non-recurrent) | £2,719,000 | 18.0 | £3,235 | £1,902,000 | 17.8 | £2,263 | £3,309,000 | 18.0 | £3,937 |
3b: Women with a previous stillbirth – known causes (recurrent) | £9,420,000 | 62.2 | £3,720 | £6,660,000 | 61.9 | £2,607 | £11,410,000 | 62.2 | £4,506 |
3c: Women with a previous stillbirth – unknown causes | £2,371,000 | 15.7 | £3,751 | £1,664,000 | 15.6 | £2,633 | £2,872,000 | 15.7 | £4,543 |
Total
|
£14,510,000
|
1.5
|
-
|
£10, 226,000
|
1.7
|
-
|
£17,591,000
|
1.6
|
-
|
Overall Total
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£943,846,000
|
95.9
|
-
|
£599,272,000
|
95.3
|
-
|
£1,116,650,000
|
95.9
|
-
|