Ashley E. Skeith

Twenty-week Abortion Bans on Pregnancies With a Congenital Diaphragmatic Hernia: A Cost-effectiveness Analysis

OBJECTIVE To estimate the effect of 20-week abortion bans on maternal and consequent neonatal health outcomes and costs in the setting of fetal congenital diaphragmatic hernia. METHODS A decision-analytic model was built using TreeAge software to evaluate the effect of a 20-week ban on abortion in a theoretical cohort of 921 women diagnosed with fetal congenital diaphragmatic hernia. Probabilities, utilities, and costs were derived from the literature. The cohort size was based on the annual rate of prenatal diagnoses of congenital diaphragmatic hernia and live births among the 20 states with bans. The threshold for cost-effectiveness was set at

Maternal Height and Perinatal Outcomes in a Trial of Labor After Cesarean [35F]

100,000 per quality-adjusted life-year. Analysis was completed from the maternal perspective. Clinical outcomes included mode of delivery, maternal death, intrauterine fetal death, neonatal death, neurodevelopmental disability, and use of extracorporeal membrane oxygenation. One-way sensitivity analysis was used on all variables and Monte Carlo simulation was performed. RESULTS A policy restricting termination was associated with higher costs, at an additional

Outcomes in Trial of Labor after Cesarean Section in Twin Pregnancies [36Q]

158,419,623, with decreased quality of life and 674 fewer quality-adjusted life-years. With 20-week bans in place, 60 women would travel out of state to obtain abortions. There would be 158 more live births affected by congenital diaphragmatic hernia. Of these births, 45 neonates would die before 28 days after birth and an additional 37 would have long-term neurodevelopmental disability. CONCLUSION In this model, bans that limit abortions beyond 20 weeks of gestation were associated with worse health outcomes and increased costs for women with pregnancies complicated by congenital diaphragmatic hernia. The restriction of health care access should be considered in terms of the long-term outcomes and economic effect on individuals and society.

Adding Azithromycin to Cephalosporin for Cesarean Delivery Infection Prophylaxis: A Cost-Effectiveness Analysis

INTRODUCTION:We sought to determine differences in perinatal outcomes associated with maternal height in the setting of a Trial of Labor After Cesarean (TOLAC).METHODS:We conducted a retrospective cohort study of 217,667 women with singleton, vertex, term gestations with a history of cesarean delive

Association of a Health Care Provider Review Meeting With Cesarean Delivery Rates: A Quality Improvement Program

INTRODUCTION:We sought to compare delivery and neonatal outcomes in twin pregnancies undergoing a trial of labor after cesarean section (TOLAC).METHODS:This retrospective cohort included 2,013 pregnancies undergoing a TOLAC and compared outcomes of cesarean section (CS) versus vaginal birth after ce

Obstetric Outcomes Associated with Maternal Syphilis Infection in U.S. Deliveries [4J]

OBJECTIVE To investigate the cost-effectiveness of adding azithromycin to standard cephalosporin regimens of cesarean delivery prophylaxis by considering the maternal outcomes in the current and potential subsequent pregnancies. METHODS A cost-effectiveness model was created using TreeAge to compare the outcomes of using azithromycin-cephalosporin with cephalosporin alone in a theoretical cohort of 700,000 women, the approximate number of nonelective cesarean deliveries annually in the United States that occur during labor or after membrane rupture. Outcomes examined included endometritis, wound infection, sepsis, venous thromboembolism, and maternal death in the current pregnancy and uterine rupture, cesarean hysterectomy, and maternal death in subsequent pregnancies, including cost and quality-adjusted life-years for both pregnancies. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at

Routine Use of Tranexamic Acid in Postpartum Hemorrhage: A Cost-Effectiveness Analysis [34O]

100,000 per quality-adjusted life-year. Sensitivity analyses were used to determine the robustness of our results. RESULTS Compared with cephalosporin alone for prophylaxis, our model showed 16,100 fewer cases of endometritis, 17 fewer cases of sepsis, eight fewer cases of venous thromboembolism, and one fewer maternal death with azithromycin-cephalosporin. Additionally, this strategy prevented 36 uterine ruptures and four cesarean hysterectomies in the subsequent pregnancy. Overall, the addition of azithromycin led to both lower costs and higher quality-adjusted life-years when compared with standard cephalosporin prophylaxis. In sensitivity analysis, we found that as long as the cost of azithromycin remained below

First Trimester Fasting Plasma Glucose Screen in Advanced Maternal Age to Detect Pre-existing Glucose Intolerance [22O]

930 (baseline cost

Prenatal Dexamethasone to Prevent Newborn Virilization From Fetal CAH: A Cost-Effectiveness Analysis [29L]

27), it was cost-effective. CONCLUSION For women who undergo cesarean delivery in labor or after membrane rupture, compared with cephalosporin alone, the addition of azithromycin to cesarean delivery infection prophylaxis is less costly and leads to better maternal outcomes in the index delivery and subsequent deliveries. These findings support the use of prophylactic azithromycin at the time of cesarean delivery.