Skip to main content
SpringerLink
Log in

Determining cost savings from attempted cephalic version in an inner city delivering population

  • Published:
Health Care Management Science Aims and scope Submit manuscript

Abstract

The use of external cephalic version (ECV) is increasingly seen as an important clinical management strategy for breech presentation infants. Currently, 75% of women with breech presentation at term undergo Cesarean delivery risking adverse outcomes and incurring higher costs. ECV, if successful, reduces the rate of breech presentation at delivery and the need for Cesarean delivery. Data from an inner-city population of delivering women were examined to determine the effectiveness of ECV among these minority, low income women. Hospital clinical and Medicaid claims data for 679 deliveries with breech presentation were studied. Decision tree analysis indicated ECV was successful for 48% of those attempted. Based on amounts billed Medicaid, attempting ECV reduced the use of resources by a little over $3,000 per delivery. Sensitivity analysis showed, however, that the savings may be as low as $906. Multivariate analysis confirmed the independent effect of attempting ECV on the probability of Cesarean delivery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American College of Obstetricians and Gynecologists (ACOG), External cephalic version, in: Practice Patterns: Evidence-Based Guidelines for Clinical Issues in Obstetrics and Gynecology, American College of Obstetricians and Gynecologists, Number 4 (1997) pp. 947–954.

    Google Scholar 

  2. A. Brosset, The value of prophylactic external version in cases of breech presentation, Acta Obstetrical et Gynecology Scandinavia 35 (1956) 555–562.

    Article  Google Scholar 

  3. J.V. Collea, C. Chein and E.J. Quilligan, The randomized management of term frank breech presentation: a study of 208 cases, American Journal of Obstetrics and Gynecology 137 (1980) 235–242.

    Google Scholar 

  4. D.P. Eller and J.P. VanDorsten, Breech presentation. Current opinion, Obstetrics and Gynecology 5 (1993) 664–668.

    Google Scholar 

  5. J.E. Ferguson, M.A. Armstrong and D.C. Dyson, Maternal and fetal factors affecting success of antepartum external cephalic version,Obstetrics and Gynecology 70(5) (1987) 722–725.

    Google Scholar 

  6. S.A. Finkler, The distinction between cost and charges, Annals of Internal Medicine 96 (1982) 102–109.

    Google Scholar 

  7. D.J. Fortunato, L.J. Mercer and D.S. Guzick, External cephalic version with tocolysis: factors associated with success, Obstetrics and Gynecology 72(1) (1988) 59–61.

    Google Scholar 

  8. M.L. Gimovsky et al., Randomized management of the non-frank breech presentation at term: a preliminary report, American Journal of Obstetrics and Gynecology 146 (1983) 34–40.

    Google Scholar 

  9. J.E. Green et al., Has an increased Cesarean section rate for term breech delivery reduced the incidence of birth asphyxia, trauma, and death, American Journal of Obstetrics and Gynecology 142 (1981) 643–648.

    Google Scholar 

  10. T. Joyce, A. Racine and N. Mocan, The consequences and costs of maternal substance abuse in New York city: a pooled time series, cross section analysis, Journal of Health Economics 11(3) (1992) 297–314.

    Article  Google Scholar 

  11. D.G. Kleinbaum, L.L. Kupper and K.E. Muller, Applied Regression Analysis and Other Multivariate Methods, 2nd ed. (PWS-Kent, Boston, 1988).

    Google Scholar 

  12. J.G. Mauldin et al., Determining the clinical efficacy and cost savings of successful external cephalic version, American Journal of Obstetrics and Gynecology 175(6) (1996) 1639–1644.

    Article  Google Scholar 

  13. J.C. Morrison et al., External cephalic version of the breech presentation under tocolysis, American Journal of Obstetrics and Gynecology 154(4) (1986) 900–903.

    Google Scholar 

  14. R.B. Newman et al., Predicting success of external cephalic version, American Journal of Obstetrics and Gynecology 169 (1993) 245–250.

    Google Scholar 

  15. A.W. Robertson et al., External cephalic version at term: is a tocolytic necessary?, Obstetrics and Gynecology 70(6) (1987) 896–899.

    Google Scholar 

  16. S.M. Taffel, P.J. Placek and T. Liff, Trends in the United States Cesarean section rate and reasons for the 1980-85 rise, American Journal of Public Health 77 (1987) 955–959.

    Article  Google Scholar 

  17. J.P. VanDorsten, B.S. Schifrin and R.L.Wallace, Randomized control trial of external cephalic version with tocolysis in late pregnancy, American Journal of Obstetrics and Gynecology 141(4) (1981) 417–424.

    Google Scholar 

  18. R.L. Wallace et al., External cephalic version with tocolysis: observations and continuing experience at the Los Angeles County/University of Southern California Medical Center, Journalof Reproductive Medicine 29(10) (1984) 745–748.

    Google Scholar 

  19. C.P. Weiner, Vaginal breech delivery in the 1990's, Clinical Obstetrics and Gynecology 35(2) (1992) 559–569.

    Google Scholar 

  20. R.C. Wright, Reduction of perinatal mortality and morbidity in breech delivery through routine use of Cesarean section, Obstetrics and Gynecology 14 (1959) 758–763.

    Google Scholar 

  21. D.S. Gifford, E. Keeler and K.L. Kahn, Reductions in cost and Cesarean rate by routine use of external cephalic version: a decision analysis, Obstetrics and Gynecology 85(6) (1995) 930–936.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA

    E. Kathleen Adams

  2. Medical University of South Carolina, Charleston, SC, USA

    Patrick D. Mauldin & Jill G. Mauldin

  3. Medical Treatment Effectiveness Center, Morehouse School of Medicine, Atlanta, GA, USA

    Robert M. Mayberry

Authors
  1. E. Kathleen Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick D. Mauldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jill G. Mauldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert M. Mayberry
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adams, E.K., Mauldin, P.D., Mauldin, J.G. et al. Determining cost savings from attempted cephalic version in an inner city delivering population. Health Care Management Science 3, 185–192 (2000). https://doi.org/10.1023/A:1019097525279

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1019097525279

Keywords

Search

Navigation