Assuntos
Administradores de Registros Médicos , Serviço Hospitalar de Registros Médicos , Mobilidade Ocupacional , Florida , Sistemas de Informação Hospitalar/organização & administração , Humanos , Gestão da Informação , Capacitação em Serviço/organização & administração , Equipes de Administração Institucional , Descrição de Cargo , Administradores de Registros Médicos/educação , Papel Profissional , Recursos HumanosRESUMO
OBJECTIVES: This study was undertaken to estimate the vaginal birth after cesarean (VBAC) success rate, compare rates of infections in women attempting VBAC and those undergoing planned repeat cesarean, and compare the cost of these two plans of care for obese women. STUDY DESIGN: We performed a historical cohort analysis of singleton deliveries at >/=36 weeks' gestation in women with a body mass index 40 or greater and one prior cesarean delivery. Outcomes included rates of VBAC success and puerperal infections and mean cost of care. RESULTS: The cohort consisted of 122 mother-infant pairs, 61 each in the VBAC and cesarean groups. In the VBAC group, 57% (95% CI 45-70) of women were delivered vaginally. The VBAC group had higher rates of chorioamnionitis (13.1% vs 1.6%, P=.02), endometritis (6.6% vs 0%, P=.06), and composite puerperal infection (24.6% vs 8.2%, P=.01). Mean cost of care was similar for mothers ($4439 vs $4427, P=.95), infants ($1241 vs $1422, P=.49), and mother-infant pairs ($5680 vs $5851, P=.64). CONCLUSION: Compared with planned cesarean delivery, VBAC trials in obese women are three times as likely to be complicated by infection and do not result in reduced costs.
Assuntos
Cesárea , Obesidade/patologia , Complicações na Gravidez/patologia , Nascimento Vaginal Após Cesárea , Adulto , Índice de Massa Corporal , Cesárea/efeitos adversos , Cesárea/economia , Corioamnionite/epidemiologia , Corioamnionite/etiologia , Estudos de Coortes , Endometrite/epidemiologia , Endometrite/etiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Infecções/epidemiologia , Infecções/etiologia , Gravidez , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Nascimento Vaginal Após Cesárea/efeitos adversos , Nascimento Vaginal Após Cesárea/economiaRESUMO
OBJECTIVE: The purpose of this study was to evaluate the relative cost-effectiveness of attempted vaginal birth after cesarean delivery compared with elective repeat cesarean delivery. STUDY DESIGN: We performed an historic cohort analysis of women with a single prior cesarean delivery who were delivered at our institution during 1999. Inclusion criteria were > or =36 weeks' gestation and carrying a live, singleton fetus with no antenatally diagnosed anomalies. The primary outcome variable was mean cost of hospital care for mother-infant pairs, as obtained from the hospital's Clinical Resources Department. RESULTS: The cohort consisted of 204 mother-infant pairs, 65 in the elective repeat cesarean group and 139 in the attempted vaginal birth group. Mean cost of care was higher for mothers ($4155 vs $3675;P <.001), neonates ($1794 vs $1187; P =.03), and mother-infant pairs ($5949 vs $4863; P =.001) for the elective repeat cesarean group compared with the attempted vaginal delivery group. CONCLUSION: In women with a single prior cesarean delivery, a trial of labor is more cost-effective than an elective repeat cesarean delivery.
