Advertisement

A randomized trial of late versus early external cephalic version for the treatment of abnormal presentation at term

      Objective

      To assess the clincal efficacy and the cost effectiveness of late v early external cephalic version (ECV).

      Study design

      Between Jan00-Jun05, all patients 36-38 wk with ultrasound documentation of an abnormal presentation (breech or transverse) were offered a trial of ECV and randomly assigned to the late (≥ 39 wk) or early (36-38 wk) group. All patients were offered SQ terbutaline and epidural anesthesia. Multiple variables analyzed and compared between groups included maternal demographics (age, race, gravity, parity), success rate, fetal ultrasound measurements (EFW, AFI, placental location, and fetal position), mode of delivery, neonatal outcome (gest age, birth wt, Apgar scores, cord entanglement & pH), and hospital costs. A sample size calculation determined 30 patients in each group would be required for statistical power.

      Results

      61 patients met criteria with 30 patients in the early and 31 in the late groups. There was no statistical difference between groups with respect to maternal demographics, ultrasound measurements, terbutaline or epidural utilization, and neonatal outcome. The comparison of success rate, mode of delivery, and length of stay (LOS) is summarized in the table below. Although overall hospital costs were significantly decreased with late ECV in direct correlation with the decreased LOS, reimbursement for late ECV was significantly reduced due to inclusion with the disease related group (DRG) derived global fee for delivery.

      Conclusion

      Late ECV (at or after 39 weeks) is as successful and has a similar cesarean section rate as early ECV. Late ECV decreases overall LOS for the patient and total cost of care for the hospital. Without a significant change in DRG derived reimbursement, there may not be economic incentive for late ECV despite its potential benefit to patient and provider.
      Tabled 1Early vs late group comparison
      Early (n = 30)Late (n = 31)P Value
      Success (%)60.067.70.7
      C/S Rate (%)56.343.80.4
      LOS (day±SD)3.8 ± 0.92.5 ± 0.8< 0.001