REDUCTIONS IN COST AND CESAREAN RATE BY ROUTINE USE OF EXTERNAL CEPHALIC VERSION - A DECISION-ANALYSIS

Objective: To describe currently accepted methods for managing the ter m breech pregnancy, and to predict the delivery outcomes and costs of each method. Methods: Literature review was used to derive four option s for the peripartum management of the term breech pregnancy. Using de cision-analysis techniques, we calculated the predicted delivery outco mes and costs associated with each option. Results: Applying external cephalic version to all term breech pregnancies without contraindicati ons to labor or version, and allowing a trial of labor for eligible wo men who fail version, results in a 25% cesarean rate, at a cost of $80 71 per case. Delivering unsuccessful versions by scheduled cesarean re sults in a 32% cesarean rate, at a cost of $8276 per case. In contrast , a strategy not using external version but allowing a trial of labor for those mothers who meet eligibility criteria results in a 63% cesar ean rate, at a cost of $8755 per case. Routinely scheduling a cesarean when a breech is identified at term results in an 89% cesarean rate, at a cost of $9544 per case. Conclusions: Although the liberal use of vaginal delivery for term breech pregnancies has been suggested as one way of lowering the cesarean rate, the addition of routine external c ephalic version to the management strategy will result in more vaginal deliveries and lower costs than strategies that allow vaginal deliver y but do not include an attempted cephalic version. Routine cesarean w ithout attempted external cephalic version results in excessive operat ive deliveries.