Mauldin J G, Mauldin P D, Feng T I, Adams E K, Durkalski V L
Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA.
Am J Obstet Gynecol. 1996 Dec;175(6):1639-44. doi: 10.1016/s0002-9378(96)70118-7.
The aim of this study was to determine predictors of successful external cephalic version and to calculate the associated cost savings achieved with success.
A retrospective study of 203 women with singleton gestations who underwent external cephalic version was performed. Descriptive, univariate, and multivariate analyses were performed on patient-specific risk data to predict successful version. National claims data were used for the cost simulation.
Higher parity (p = 0.02), transverse-oblique presentation (p = 0.001), posterior placenta (p = 0.001), and a longer duration of pregnancy (p = 0.001) significantly increased the likelihood of a successful version. Heavier maternal weight was negatively associated with successful version (p = 0.05). The cost simulation revealed an average savings of $2462 for each successful version.
This study identifies clinical variables associated with an increased external cephalic version success rate. If, in fact, successful external cephalic version reduces both maternal and fetal morbidity associated with cesarean delivery and, as demonstrated in this analysis, the costs associated with the delivery, then greater effort should be made to maximize the success rate of external cephalic version.
本研究旨在确定外倒转术成功的预测因素，并计算成功实施外倒转术所节省的相关成本。
对203名单胎妊娠且接受外倒转术的女性进行回顾性研究。对患者特定风险数据进行描述性、单变量和多变量分析，以预测外倒转术成功与否。使用国家索赔数据进行成本模拟。
较高的产次（p = 0.02）、横位-斜位胎位（p = 0.001）、胎盘后置（p = 0.001）以及较长的孕周（p = 0.001）显著增加了外倒转术成功的可能性。孕妇体重较重与外倒转术成功呈负相关（p = 0.05）。成本模拟显示，每次成功的外倒转术平均节省2462美元。
本研究确定了与外倒转术成功率增加相关的临床变量。事实上，如果成功的外倒转术能降低剖宫产相关的母婴发病率，并且如本分析所示，能降低分娩相关成本，那么就应做出更大努力以最大化外倒转术的成功率。
