Advertisement

Timing of elective repeat cesarean delivery at term and neonatal outcomes: a cost analysis

      Objective

      The purpose of this investigation was to examine the economic impact of performing elective repeat cesarean during 37 or 38 weeks of gestation relative to the American College of Obstetricians and Gynecologists recommendation of a 39-week delivery.

      Study Design

      Decision analysis modeling was used to estimate economic outcomes for a hypothetical cohort of neonates using data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network study of “Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes.” Costs and charges were estimated using the Florida Healthcare Cost and Utilization Project.

      Results

      A total of 82,541 deliveries occurring between 37-39 completed weeks of gestation were analyzed for the incidence of adverse outcomes and their hospital costs and charges. The model demonstrated increased costs through increasing adverse outcomes among elective repeat cesarean deliveries performed <39 weeks of gestation.

      Conclusion

      Our findings suggest that there are benefits to waiting until 39 weeks of gestation to perform an elective repeat cesarean delivery.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hamilton B.E.
        • Martin J.A.
        • Ventura S.J.
        Births: preliminary data for 2007.
        National Center for Health Statistics, Hyattsville, MD2009
        • Hansen A.K.
        • Wisborg K.
        • Uldbjerg N.
        • Henriksen T.B.
        Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study.
        BMJ. 2008; 336: 85-87
        • Laye M.R.
        • Dellinger E.H.
        Timing of scheduled cesarean delivery in patients on a teaching versus private service: adherence to American College of Obstetricians and Gynecologists guidelines and neonatal outcomes.
        Am J Obstet Gynecol. 2006; 195: 577-582
        • Morrison J.J.
        • Rennie J.M.
        • Milton P.J.
        Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section.
        Br J Obstet Gynaecol. 1995; 102: 101-106
        • Riskin A.
        • Abend-Weinger M.
        • Riskin-Mashiah S.
        • Kugelman A.
        • Bader D.
        Cesarean section, gestational age, and transient tachypnea of the newborn: timing is the key.
        Am J Perinatol. 2005; 22: 377-382
        • Tita A.T.
        • Landon M.B.
        • Spong C.Y.
        • et al.
        Timing of elective repeat cesarean delivery at term and neonatal outcomes.
        N Engl J Med. 2009; 360: 111-120
        • Zanardo V.
        • Simbi A.K.
        • Franzoi M.
        • Solda G.
        • Salvadori A.
        • Trevisanuto D.
        Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery.
        Acta Paediatr. 2004; 93: 643-647
        • Abouzeid H.
        • Aggarwal D.
        • De Graaf F.
        Timing of planned repeated caesarean section: an enigma.
        J Obstet Gynaecol. 2007; 27: 798-801
        • Schreiner R.L.
        • Stevens D.C.
        • Smith W.L.
        • Lemons J.A.
        • Golichowski A.M.
        • Padilla L.M.
        Respiratory distress following elective repeat cesarean section.
        Am J Obstet Gynecol. 1982; 143: 689-692
        • Bowers S.K.
        • MacDonald H.M.
        • Shapiro E.D.
        Prevention of iatrogenic neonatal respiratory distress syndrome: elective repeat cesarean section and spontaneous labor.
        Am J Obstet Gynecol. 1982; 143: 186-189
        • Committee on Educational Bulletins of the American College of Obstetricians and Gynecologists
        ACOG educational bulletin: assessment of fetal lung maturity, No. 230, November 1996.
        Int J Gynaecol Obstet. 1997; 56: 191-198
        • Agency for Health Care Research and Quality
        Healthcare cost and utilization project (HCUP) state inpatient databases (SID) 2007.
        (Accessed Feb. 1, 2010)
        • US Bureau of Labor Statistics, Division of Consumer Prices and Price Indexes
        Consumer price index.
        (Accessed Jan. 31, 2010)
        • Spong C.Y.
        • Landon M.B.
        • Gilbert S.
        • et al.
        Risk of uterine rupture and adverse perinatal outcome at term after cesarean delivery.
        Obstet Gynecol. 2007; 110: 801-807
        • Robinson P.
        • Xu X.
        • Keeton K.
        • Fenner D.
        • Johnson T.R.
        • Ransom S.
        The impact of medical legal risk on obstetrician-gynecologist supply.
        Obstet Gynecol. 2005; 105: 1296-1302