Cardiovascular disease (CVD) has surpassed the traditional causes of pregnancy-related mortality, including hemorrhage and thromboembolism in the United States. CVD accounts for ~15.5% of all pregnancy-related deaths. Pregnancy is a “natural cardiovascular stress test” for a woman. The physiological changes in the maternal hemodynamics that are geared to accommodate the growing needs of the fetal-placental unit may also lead to symptoms that are indistinguishable from those of CVD, especially in the third trimester of pregnancy. It is imperative that an obstetric provider is able to differentiate symptoms of normal pregnancy from those of a pathologic process.

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26838 more pregnancies with 2 survivors. Furthermore, there were 4649 fewer cases of NDI. On one-way sensitivity analyses, if the probability of NDI after SFLP for pregnancies affected by stage I TTTS was above 0.078, then EM was the cost-effective strategy (Figure). MCA demonstrated that SFLP was cost-effective in 98.1% of runs. CONCLUSION: With base-case estimates, SFLP is a more cost-effective strategy than EM for the treatment of Stage I TTTS. However, given the limited data informing base-case estimates, further determination of outcome probabilities is needed to determine with high confidence which strategy is more cost-effective.

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