Introduction. Views on the conduct of labor have changed over time, and a
significant difference exists in relation to obstetric centers. Objective. To
assess cost, clinical outcomes and cost-effectiveness of different types of
labor in singleton pregnancies. Methods. A decision model was used to compare
vaginal labor, induced labor and planned cesarean section. All data were
taken from the Book of Labor from the University Hospital for Gynecology and
Obstetrics ?Narodni Front?, Belgrade, Serbia for labors conducted during one
month period in 2011. Successful delivery (i.e. labor that began up to 42
gestation weeks, without maternal mortality and the newborn Apgar scores
greater than or equal to seven in the fifth minute of life) was considered as
the outcome of the cost effectiveness-analysis. To test the robustness of
this definition probabilistic sensitivity analysis was performed. Results.
From a total of 667 births, vaginal labor was conducted in 98 cases, induced
vaginal in 442, while planned cesarean section was performed 127 times.
Emergency cesarean section as a complication was much higher in the vaginal
labor cohort compared to the induced vaginal cohort (OR=17.374; 95% CI: 8.522
to 35.418; p<0.001). The least costly type of labor was induced vaginal
labor: average cost 461 euro, with an effectiveness of 98.17%. Both, vaginal
and planned cesarean labor were dominated by the induced labor. The results
were robust. Conclusion. Elective induction of labor was associated with the
lowest cost compared to other types of labor, with favorable maternal and
neonatal outcomes.
579: Operative vaginal delivery compared to cesarean section modeled for a second pregnancy: a cost-effectiveness analysis