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OBJECTIVE:To compare pregnancy and economic outcomes in women receiving inpatient vs outpatient tocolysis with continuous subcutaneous terbutaline (SQT). STUDY DESIGN:Identified within a database were women prescribed SQT at 24.0 to 33.9 weeks' gestation following stabilization of an acute episode of preterm labor. Women with cervical dilatation >3 cm, and/or maternal or fetal instability were excluded. Those with prolonged inpatient care were matched 1:1 to those discharged with outpatient follow-up by cervical dilatation, gestational age, and fetal number yielding 90 matched pairs (180 women). RESULTS:Inpatients had an earlier gestational age at delivery (34.1±2.9 vs 35.8±1.9 weeks, p<0.001), higher preterm birth rate (86.7% vs 74.4%, p ¼ 0.043) and higher overall costs ($56,089±$47,944 vs $25,540±$25,847, p<0.001) than outpatients. CONCLUSION:Outpatient management resulted in improved pregnancy outcomes at a cost less than that of inpatient management in this analysis of women treated with SQT.

The aim of this study was to evaluate the cost savings of outpatient management services for women with pregnancy-related hypertensive conditions. The outpatient management program included verbal and written patient education related to the hypertensive disease process during pregnancy as well as self-care procedures. Biometric data (ie, automated blood pressure measurement, qualitative urine protein) were collected at least daily by the patient and transmitted telephonically to a nursing call center. Data were evaluated and subjective symptoms assessed daily. Electronic records were maintained and reports provided to the prescribing physician and case manager. Included for analysis were: patients with pregnancy-related hypertensive conditions receiving outpatient services between January 1999 and November 2003, singleton gestation, no history of chronic hypertension, and gestational age of 20.0-36.9 weeks at start of outpatient program (n = 1,140). Maternal characteristics, antenatal hospitalization and length of stay, progression of disease, and neonatal outcome were analyzed. To evaluate cost-effectiveness, a model was developed to compare the cost of the program plus adjunctive antenatal hospitalization, to control data. The mean gestational age at program start was 32.6 weeks. Antenatal hospital admission was required for 24.8% of patients, with a mean length of stay of 2.3 days per admission. Progression to severe preeclampsia occurred in 14.3% of patients. Mean gestational age at delivery was 37.0 weeks. Antepartum charges averaged 10,327 US dollars per control patient and 4,888 US dollars per program patient, a difference of 5,439 US dollars. For each dollar spent on outpatient management, an average of 2.50 US dollars was saved. Utilizing outpatient management services for women with pregnancy-related hypertension reduces the need for inpatient care and is cost-effective.

OBJECTIVE:To identify the etiology and impact of preterm delivery in twin gestations. STUDY DESIGN:Twin gestations delivered at 33.0 to 36.9 weeks were identified in a perinatal database, and categorized by indication for delivery. Deliveries were identified as indicated, or non-indicated (discretionary). Neonatal outcomes were measured by birth weight, length of stay, NICU admission, and ventilator utilization. Data were divided and analyzed by indicated or discretionary delivery, and gestational age at delivery. RESULTS:Analyzed were 3252 twin gestations (6504 infants), with 78% having indicated delivery. Of the 22% with discretionary delivery, nearly 40% required NICU admission. With each advancing week of gestation, there was a significant decrease in incidence of NICU admission and nursery days. CONCLUSION:The majority of preterm deliveries were indicated, though 22% were discretionary. It is vital to consider neonatal morbidity and costs related to gestational age when choosing discretionary delivery.

Spontaneous preterm delivery occurred in 63.0% of singletons and 87.9% of twins. Although stable at SQT discontinuation, 32.5% of singletons and 59.9% of twins delivered within three days. The interval from discontinuation of SQT to delivery was less for twin than singleton gestations (5.1 +/- 6.5 vs. 11.0 +/- 10.5 days, respectively, p < 0.001). CONCLUSIONS. Preterm discontinuation of SQT should be avoided if additional pregnancy prolongation is desired.