Adams E K, Mauldin P D, Mauldin J G, Mayberry R M
Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Health Care Manag Sci. 2000 Jun;3(3):185-92. doi: 10.1023/a:1019097525279.
The use of external cephalic version (ECV) is increasingly seen as an important clinical management strategy for breech presentation infants. Currently, 75% of women with breech presentation at term undergo Cesarean delivery risking adverse outcomes and incurring higher costs. ECV, if successful, reduces the rate of breech presentation at delivery and the need for Cesarean delivery. Data from an inner-city population of delivering women were examined to determine the effectiveness of ECV among these minority, low income women. Hospital clinical and Medicaid claims data for 679 deliveries with breech presentation were studied. Decision tree analysis indicated ECV was successful for 48% of those attempted. Based on amounts billed Medicaid, attempting ECV reduced the use of resources by a little over $3,000 per delivery. Sensitivity analysis showed, however, that the savings may be as low as $906. Multivariate analysis confirmed the independent effect of attempting ECV on the probability of Cesarean delivery.
外倒转术（ECV）的应用日益被视为臀位分娩婴儿的一项重要临床管理策略。目前，75%足月臀位产妇接受剖宫产，面临不良后果且成本更高。若外倒转术成功，则可降低分娩时臀位的发生率以及剖宫产的需求。对城市中心区分娩女性群体的数据进行了研究，以确定外倒转术在这些少数族裔、低收入女性中的有效性。研究了679例臀位分娩的医院临床和医疗补助索赔数据。决策树分析表明，尝试外倒转术的产妇中有48%成功。根据向医疗补助部门申报的费用，尝试外倒转术可使每次分娩的资源使用减少略多于3000美元。然而，敏感性分析显示，节省的费用可能低至906美元。多变量分析证实了尝试外倒转术对剖宫产概率的独立影响。
