Cost-effectiveness of two interventions for the prevention of postpartum hemorrhage in Senegal.

OBJECTIVE: To compare, at the community level, the cost-effectiveness of oxytocin and misoprostol for the prevention of postpartum hemorrhage (PPH). METHODS: The present cost-effectiveness study used data collected during a randomized trial that compared the prophylactic effectiveness of misoprostol and oxytocin for the prevention of PPH in a rural setting in Senegal between June 6 and September 21 2013. The two interventions were compared, with referral to a higher level facility owing to PPH being the outcome measure. The costs and effects were calculated for two hypothetical cohorts of patients delivering during a 1-year period, with each cohort receiving one intervention. A comparison with a third hypothetical cohort receiving the current standard of care was included. A sensitivity analysis was performed to estimate the impact of variations in model assumptions. RESULTS: The cost per PPH referral averted was US$ 38.96 for misoprostol and US$ 119.15 for oxytocin. In all the scenarios modeled the misoprostol intervention dominated, except in the worst-case scenario, where the oxytocin intervention demonstrated slightly better cost-effectiveness. CONCLUSION: The use of misoprostol for PPH prophylaxis could be cost effective and improve maternal outcomes in low-income settings.

Acquired ileal atresia complicating an ileocolic intussusception in a 4-month-old infant.

We report a 4-month-old female infant who was apparently well before the onset of vomiting, abdominal distension, and the passage of red currant jelly stools. A clinical diagnosis of intussusception was made, and the infant was prepared for a laparotomy. Intraoperative findings were a gangrenous ileocolic intussusception with a proximal atretic ileal segment (similar to a type IIIa ileal atresia). An extended right hemicolectomy including the atretic ileal segment was done with an ileotransverse anastomosis to establish bowel continuity. The patient had a wound dehiscence on the fourth postoperative day that was repaired. She subsequently made satisfactory clinical recovery and was discharged on the 10th day.