Reductions in Cost and Cesarean Rate by Routine Use of External Cephalic Version

A Decision Analysis

Published In: Obstetrics and Gynecology, v. 85, no. 6, June 1995, p. 930-936

Posted on RAND.org on January 01, 1995

by Deidre S. Gifford, Emmett B. Keeler, Katherine L. Kahn

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More than 80 percent of breech infants are currently delivered by cesarean section. This article describes the accepted methods for managing the term breech pregnancy and uses decision analysis to predict the cost of four methods of delivery. Costs for the four methods include the following: (1) external cephalic version for all term breech pregnancies without contraindications to labor or version, and allowing a trial of labor for eligible women who fail version: almost $8,100 per case, with 25 percent cesarean rate; (2) unsuccessful versions delivered by scheduled cesarean: almost $8,300 per case, with 32 percent cesarean rate; (3) trial of labor for mothers who meet eligibility criteria: almost $8,800 per case, with 63 percent cesarean rate; and (4) routine scheduling of cesarean when a breech is identified at term: more than $9,500 per case, with 89 percent cesarean rate. The article concludes that the addition of routine external cephalic version to the management strategy results in more vaginal deliveries and lower costs than if vaginal delivery is attempted that does not include an attempted cephalic version.

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