Fonseca Linda, Monga Manju, Silva Jeannie
Department of Obstetrics, Gynecology, and Reproductive Science, University of Texas Houston Medical School, 6431 Fannin, Houston, TX 77030, USA.
Am J Obstet Gynecol. 2003 May;188(5):1214-6. doi: 10.1067/mob.2003.287.
The objective of this study was to determine the comparative financial burden of twice-weekly fetal testing from 41 weeks of gestation until delivery, as compared with early dating ultrasound evaluation in an indigent population.
All women who were seen for antepartum testing for postdating pregnancy at Lyndon Baines Johnson Hospital were enrolled. Patient age, parity, gestational age at initiation of prenatal care, the number of prenatal visits, gestational age at first ultrasound scan, and the number of biophysical profiles that were performed before delivery were recorded. The labor and delivery database was searched for all deliveries at >41 weeks of gestation. The charge for a single ultrasound scan at <20 weeks of gestation was compared with twice-weekly testing in the population as a whole with the use of three strategies (no dating ultrasound scans and biophysical profiles until delivery, routine dating ultrasound scan and routine induction at 41 weeks of gestation, and current practice at our institution).
One hundred twenty-seven subjects with postdated pregnancy were enrolled (mean age, 25.2 years; median parity, 0 [range, 0-6]). The mean gestational age at the initiation of prenatal care was 21.2 +/- 10.5 weeks. Forty-seven women (38.0%) initiated care at <20 weeks. The mean number of biophysical profiles performed before delivery was 1.5 +/- 1.34; the mean gestational age at delivery was 42.1 +/- 0.87 weeks (spontaneous labor, 39.6%; induced labor, 40.4%). The charge for a biophysical profile is $492.90 US dollars and $551.00 US dollars for a 20-week ultrasound scan; there is no difference in the charge for induced or spontaneous labor. During the 4-month study period, 1638 patients were delivered at our hospital; 341 patients were delivered at >41 weeks of gestation. The estimated financial burden of antenatal testing of 341 patients from 41 weeks to delivery was calculated to be $252,118 US dollars, compared with $902,538 US dollars for a single ultrasound scan at 20 weeks for the entire population of 1638 patients. The estimated financial burden of current practice (10% of patients with no prenatal care, 38% of patients with examination at <20 weeks who were eligible for dating ultrasound scanning, and 37% of patients with examination for postdate testing) was $402,457 US dollars.
Patients who were seen for postdate antepartum testing in an indigent population lack early initiation of prenatal care and early ultrasound scans. Because on average only 1.5 biophysical profiles are performed per patient before delivery, routine early ultrasound scanning and routine induction at 41 weeks of gestation would add considerable financial burden to the system.
本研究的目的是确定在贫困人群中，与早期超声孕周评估相比，妊娠41周直至分娩期间每周两次的胎儿检测的相对经济负担。
纳入所有在林登·贝恩斯·约翰逊医院接受过期妊娠产前检测的妇女。记录患者年龄、产次、产前检查开始时的孕周、产前检查次数、首次超声扫描时的孕周以及分娩前进行的生物物理评分次数。在分娩和接生数据库中搜索所有妊娠>41周的分娩病例。使用三种策略（直至分娩均不进行孕周超声扫描和生物物理评分、常规孕周超声扫描并在妊娠41周时常规引产、以及我们机构的现行做法），将妊娠<20周时单次超声扫描的费用与整个人群中每周两次检测的费用进行比较。
纳入127例过期妊娠受试者（平均年龄25.2岁；中位产次0[范围0 - 6]）。产前检查开始时的平均孕周为21.2±10.5周。47名妇女（38.0%）在<20周时开始产检。分娩前进行的生物物理评分的平均次数为1.5±1.34；分娩时的平均孕周为42.1±0.87周（自然分娩占39.6%；引产占40.4%）。一次生物物理评分的费用为492.90美元，20周超声扫描的费用为551.00美元；引产或自然分娩的费用没有差异。在4个月的研究期间，我院共分娩1638例患者；341例患者在妊娠>41周时分娩。计算得出341例患者从41周直至分娩的产前检测估计经济负担为252,118美元，而1638例患者全体进行一次20周超声扫描的费用为902,538美元。现行做法（10%未进行产前检查的患者、38%在<20周时接受检查且符合孕周超声扫描条件的患者、以及37%接受过期检测检查的患者）的估计经济负担为402,457美元。
贫困人群中接受过期妊娠产前检测的患者缺乏早期产前检查和早期超声扫描。由于每位患者在分娩前平均仅进行1.5次生物物理评分，妊娠41周时常规早期超声扫描和常规引产会给系统增加相当大的经济负担。
