Objective-To evaluate whether administration of antenatal late-preterm betamethasone is costeffective in the immediate neonatal period. Study Design-Cost-effectiveness analysis of late-preterm betamethasone administration with a time horizon of 7.5 days was conducted using a health-system perspective. Data for neonatal outcomes, including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), and hypoglycemia, were from the Antenatal Betamethasone for Women at Risk for Late Preterm Delivery trial. Cost data were derived from the Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality, and utilities of neonatal outcomes were from the literature. Outcomes were total costs in 2017 United States dollars and quality-adjusted life-years (QALYs) for each individual infant as well as for a theoretical cohort of the 270,000 late-preterm infants born in 2015 in the United States.

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increased costs and probably adverse events related to analgesia. We aimed to examine whether an ECV attempt followed by a repeat attempt under spinal anesthesia (SA) in cases of failure only, still increases the success rate compared with one step without analgesia. STUDY DESIGN: A retrospective study conducted at a single university teaching hospital on data from January 2009 to December 2015. All women with non-vertex singleton gestation, at >37 weeks who had an ECV attempt without SA were included. Women who had a failed ECV were offered a repeat attempt under SA between 38 to 39 weeks. Women who refused a second attempt were offered a scheduled CD at 39 to 40 weeks. The primary outcome was the incidence of vertex presentation at delivery. Secondary outcomes were the rate of successful repeat attempt and CD rate. RESULTS: Of all 213 ECV attempts without analgesia, 145 (68.1%) were successful. Of the reminder 68 women who had a failed first attempt, 5 (7.3%) had subsequent spontaneous version to cephalic presentation, 5 (7.3%) delivered at another institution and 13 (19.1%) went into spontaneous labor. Among the reminder 45 (66.2%) women, 17 refused a second attempt and 28 agreed for a second attempt with SA. Successful ECV with SA occurred in 11 women (39.3%) and all had vertex presentation at delivery compared to none (0%) of the 17 who refused a second attempt (p¼0.003). The CD rate was 64.3% compared to 100% respectively (p¼0.007). CONCLUSION: Repeat ECV with SA after first attempt failure increased the rate of vertex presentation at birth and decreased the CD rate. This 2 steps approach compared to neuraxial analgesia for all, require fewer recourses and costs and probably encompasses fewer adverse events related to SA since not all women need to be exposed.

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OBJECTIVE: Mid-trimester Uterine Artery (UtA) resistance measured with Doppler sonography is known to be predictive for preeclampsia and thus iatrogenic preterm birth (iPTB). In view of the emerging association between hypertensive disease in pregnancy and spontaneous preterm birth (sPTB), we hypothesized that UtA resistance could predict sPTB. STUDY DESIGN: We performed a prospective cohort study. During the 18-22 week routine fetal anomaly scan we measured UtA resistance in singleton pregnancies. Pregnancies complicated by major congenital anomalies were excluded. We classified the resistance in the uterine artery (no notch, unilateral notch or bilateral notch) and related it to sPTB and iPTB, defined as delivery before 37 weeks, using likelihood ratios. Furthermore, we assessed whether the UtA Pulsatility Index (PI) was associated with the risk of sPTB. RESULTS: Between January 2009 and December 2016, we included 2,987 women. Mean gestational age at measurement was 19+6 weeks. There were 79 (2.6%) women with a bilateral notch and 134 (4.5%) with a unilateral notch. Mean gestational age at birth was 39+0 weeks, 6.3 % had sPTB while 4.0 % had iPTB. Mean UtA resistance was 1.11 in the sPTB group compared to 1.05 in the term group (p <0.001). The risk of PTB was increased with high UtA resistance (OR 2.6 per unit ; 95% CI 2.0-3.4). Figure 1 shows the time to delivery. The prevalence of spontaneous preterm birth increased from 6.1% in women with normal uterine arteries to 9.0% in women with a unilateral notch and 10.1% in women with a bilateral notch (Table 1). For iPTB, these rates were 3.4%, 9.0% and 19.0% respectively. Likelihood ratios for the prediction of sPTB were 1.5 (95% CI 0.8-2.7) and 1.7 (95% CI 0.8-3.6) for unilateral and bilateral notches respectively, and 2.6 (95% CI 1.4-4.6) and 6.0 (95% CI 3.3-10.3) for iPTB. Of all women with bilateral notching 29.1% delivered preterm. CONCLUSION: Mid-Trimester UtA resistance measured at 19 weeks gestation predicts sPTB.