Reattempting failed external cephalic version under epidural anesthesia

Neiger, Ran; Hennessy, Mark; Patel, Melan

doi:10.1016/s0002-9378(98)70120-6

Cited by 36 publications

(14 citation statements)

References 11 publications

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“…For example, the probability of successful ECV on the second trial used in our base case analysis was calculated to be 51%. This value was derived from three studies reporting repeat ECV success rates of 39.7% (27/68) [22], 71% (77/108) [23], and 17% (6/36) [24], where the numerators represent successful cases and denominators represent total number of subjects in their respective study. The ranges for our sensitivity analysis were derived from the upper and lower probability values identified in the literature review.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of external cephalic version for term breech presentation

Tan

Macario

Carvalho

et al. 2010

BMC Pregnancy Childbirth

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BackgroundExternal cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation.MethodsA computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and $5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness.ResultsThe incremental cost-effectiveness of ECV, assuming a baseline 58% success rate, equaled $7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean.ConclusionsFrom society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.

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Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of external cephalic version for term breech presentation

Tan

Macario

Carvalho

et al. 2010

BMC Pregnancy Childbirth

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“…Two studies had no control groups. 66,67 Many factors that can influence the success of ECV are often inadequately controlled in studies and may account for the heterogeneity among the studies reviewed. For example, although investigators in all studies used tocolysis, which is known to increase the ECV success rate, they used different types and routes of administration.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies performed prospective trials on patients undergoing repeat ECV. 66,67 Rozenberg performed the first ECV with no analgesia and the second ECV a week later with epidural anesthesia, 66 Neiger offered patients with a previous failed ECV a second ECV under epidural anesthesia, 67 while Birnbach performed a prospective open study comparing women who refused spinal block as the control group to those receiving spinal block. 65 In these six studies combined, 366 women participated; 203 women received a neuraxial blockade and 163 women did not.…”

Section: Non-randomized and Retrospective Clinical Studiesmentioning

confidence: 99%

“…65 In these six studies combined, 366 women participated; 203 women received a neuraxial blockade and 163 women did not. Table 2 Demographic, obstetric and procedure data of randomized controlled studies Mancuso 60 Dugoff 62 Schorr 61 Weiniger 33 Sullivan 35 67 Four studies used anesthetic doses versus no analgesia in the control groups, 36,63,64,66 whereas Birnbach administered analgesic doses of intrathecal sufentanil (10 lg) to their study patients 65 and intravenous meperidine 50 mg to their controls. Demographic, obstetric and other clinical data of these six studies are outlined in Table 5.…”

Section: Non-randomized and Retrospective Clinical Studiesmentioning

confidence: 99%

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Neuraxial blockade for external cephalic version: a systematic review

Sultan

Carvalho

2011

International Journal of Obstetric Anesthesia

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“…To date, the effectiveness of neuraxial anesthesia for ECV has been evaluated in 1,112 patients in 14 studies: 572 patients received a neuraxial technique and 540 received either intravenous analgesia or no analgesia (Table). [11][12][13][14][15][16][17][18][19][20][21][22][23][24] For major complications, including emergency Cesarean delivery, persistent bradycardia, and placental abruption, there appears to be no difference in the incidence of 11,15,20 (two NA vs two NNA), and 14 cases of persistent bradycardia 12,18,19 (eight NA vs six NNA). It is important to recognize that some of these studies, particularly the non-randomized ones, failed to report specifically on the incidence of complications, making this information more difficult to interpret.…”

mentioning

confidence: 99%