Cost of bacterial vaginosis in pregnancy. Decision analysis and cost evaluation of a clinical study in Germany.

OBJECTIVE: To estimate the economic impact of screening for and treatment of bacterial vaginosis during early pregnancy. STUDY DESIGN: Data from a clinical study that aligned two screening and treatment strategies and a no-screening or treatment strategy with three gynecologic practices in Berlin were used in decision tree analysis. Costs applied to the clinical outcomes were determined from standard German references and the charges from university clinics. RESULTS: Practices A and B screened all 600 patients in the early second trimester and treated the positive cases with clindamycin 2% vaginal cream (A) or a Lactobacillus preparation (B), which incurred lower total costs, $493,159 and $497,619, as compared to practice C (total costs, $534,926), which did not screen or treat for bacterial vaginosis. Including costs of screening and treatment, the net savings of practice A as compared to practice C was estimated to be $47,316. CONCLUSION: The presence of more preterm, premature and low-birth-weight infants added costs for practice C. The estimated cost savings lend support to the value of screening and treatment for bacterial vaginosis in early pregnancy.

[Changes in the 13,14-dihydro-15-ketoprostaglandin F2alpha and oxytocin level in the 1st trimester following beta-sympathomimetic and intracervical prostaglandin E2 gel administration]. / Veränderungen der PGFM- und Oxytocin-Spiegel im 1. Trimenon unter Einfluss von Beta-Sympathikomimetika nach intrazervikaler Prostaglandin-E2-Gel-Applikation.

3 ml tylose gel containing 500 micrograms PGE2 was injected into the cervical canal of 23 patients prior to first trimester abortion. 11 patients received 5 mg fenoterol orally before the PGE2-gel application and 12 patients a placebo tablet. The PGFM and oxytocin concentrations in plasma were determined radioimmunologically. The results showed the dominant role of elevated PGFM levels in the clinical prevalence of pain during induced abortion.

Preoperative cervical priming by intracervical application of a new sulprostone gel.

In a prospective, randomised dose-finding study involving 60 women scheduled for termination of 1st trimester pregnancy, 25 micrograms, 50 micrograms or 100 micrograms of a sulprostone gel with a constant injection volume of 2.5 ml were applied intracervically 6-8 hours before curettage. The gelatinising agent was Pluronic F 127, which is liquid at temperatures less than 20 degrees C but gelatinises immediately at body temperature. A sterile, ready-to-use gel can be produced within a minute by mixing the active substance with the gelatinising agent; this rules out any loss of activity due to storage of the substances. The priming effect was verified in 30 patients by means of comparative examinations with a special tonometer before application of the gel and immediately before the surgical procedure. The 100-micrograms dosage proved to be the most effective method in nulliparae, achieving a mean free patency (i.e. force less than 1 Newton) of 8.7 mm. In primiparae and multiparae, a comparable good effect was achieved with the 50-micrograms dose. After application of 25 micrograms sulprostone gel, the mean free patency was only 5.3 mm in the nulliparae and 8.5 mm in the primiparae and multiparae. The results of the tonometric studies agreed with the clinical documentation of the priming effect, which was assessed by means of a special score. The efficiency of the cervical priming correlated with the rate of vaginal bleeding and with the frequency of contraction-related lower abdominal pain. According to the present results, local application of this sulprostone gel represents a practicable and promising method for preoperative cervical priming because of its special electromechanical properties.