Choosing mode of delivery after previous caesarean birth

Background The prevalence of autistic spectrum disorder(ASD) has increased in recent decades. The definitive causesof ASD have yet to be recognized. Howevei; it is believed thatboth genetic and non-genetic, as well as perinatal and post natalfactors influence ASD. Previous studies have shown inconsistentfindings.Objectives To assess for prematurity, birth weight, asphyxia,mode of delivery, bleeding during pregnancy, parental age andeducation, as prognostic factors for ASD.Methods We conducted a cross sectional study at schools forautistic children in Yogyakarta between February 2011 to October2012. The inclusion criteria were children with and without ASD,whose parents consented to participate in this study. Childrenwith genetic abnormalities or who planned to move away duringthe study period were excluded. A total of 48 subjects with ASDand 96 subjects without ASD were involved in this study. Datawere obtained by direct interview using questionnaires. Logisticregression analysis was performed to examine the hypoth esis.Results Multivariate analysis showed that prematurity was nota significant prognostic factor (RR 2.73; 95%CI 0.3 to 15.7) forASD. Howevei; children born by Caesarean section were 5.4 timesmore likely to have ASD (RR 5.4; 95%CI 1.3 to 22.8) comparedto those who were delivered vaginally or by vacuum extraction.Moreovet; asphyxia was also a significant prognostic factor forASD (RR 8.7; 95%CI 1.9 to 38.6) .Conclusion Prematurity is not a risk factor for ASD. Asphyxiaand Caesarean birth should be considered as potential confoundersin this study.

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Payment mechanism for institutional births in Nepal

Archives of Public Health ◽

10.1186/s13690-021-00680-7 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Ashish KC ◽

Mats Målqvist ◽

Amit Bhandari ◽

Rejina Gurung ◽

Omkar Basnet ◽

...

Keyword(s):

Hospital Stay ◽

Mode Of Delivery ◽

Transportation Cost ◽

Universal Coverage ◽

Medical Services ◽

Incentive Scheme ◽

Duration Of Stay ◽

Caesarean Birth ◽

Demand Side Financing ◽

Mode Of Birth

Abstract Background Since the Millennium Development Goal era, there have been several efforts to increase institutional births using demand side financing. Since 2005, Government of Nepal has implemented Maternity Incentive Scheme (MIS) to reduce out of pocket expenditure (OOPE) for institutional birth. We aim to assess OOPE among women who had institutional births and coverage of MIS in Nepal. Method We conducted a prospective cohort study in 12 hospitals of Nepal for a period of 18 months. All women who were admitted in the hospital for delivery and consented were enrolled into the study. Research nurses conducted pre-discharge interviews with women on costs paid for medical services and non-medical services. We analysed the out of pocket expenditure by mode of delivery, duration of stay and hospitals. We also analysed the coverage of maternal incentive scheme in these hospitals. Results Among the women (n-21,697) reporting OOPE, the average expenditure per birth was 41.5 USD with 36 % attributing to transportation cost. The median OOPE was highest in Bheri hospital (60.3 USD) in comparison with other hospitals. The OOPE increased by 1.5 USD (1.2, 1.8) with each additional day stay in the hospital. There was a difference in the OOPE by mode of delivery, duration of hospital-stay and hospital of birth. The median OOPE was high among the caesarean birth with 43.3 USD in comparison with vaginal birth, 32.6 USD. The median OOPE was 44.7 USD, if the women stayed for 7 days and 33.5 USD if the women stayed for 24 h. The OOPE increased by 1.5 USD with each additional day of hospital stay after 24 h. The coverage of maternal incentive was 96.5 % among the women enrolled in the study. Conclusions Families still make out of pocket expenditure for institutional birth with a large proportion attributed to hospital care. OOPE for institutional births varied by duration of stay and mode of birth. Given the near universal coverage of incentive scheme, there is a need to review the amount of re-imbursement done to women based on duration of stay and mode of birth.

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The true relative financial cost of Planned Caesarean Birth (PCB) versus Planned Vaginal Birth (PVB) in England for the year 2018/19 taking into account litigation and compensation for harm: a sensitivity analysis.

10.22541/au.160788472.25524444/v1 ◽

2020 ◽

Author(s):

Jonathan West ◽

Myles Taylor ◽

Michael Magro

Keyword(s):

Sensitivity Analysis ◽

Mode Of Delivery ◽

Design Sensitivity ◽

Vaginal Birth ◽

Cost Advantage ◽

Financial Cost ◽

Caesarean Birth ◽

Financial Costs ◽

Mode Of Birth ◽

Additional Costs

OBJECTIVE: To determine the true financial costs of Planned Caesarean Section and Planned Vaginal Birth in England for the year 2018/19 after accounting for litigation and compensation for harm (LCFH) DESIGN: Sensitivity analysis BACKGROUND: Average base costs per delivery remitted to NHS maternity providers for Planned Caesarean Birth (PCB) and Planned Vaginal Birth (PVB) in 2018/19 were £3,948 and £3,270 respectively leading to a perception that PCB is more costly than PVB. Indemnity costs potentially related to planned mode of delivery, however, add an average of £1,571/delivery to overall costs. METHOD: Retrospective analysis of costs according to planned mode of birth was performed based on data and previous research published by NHS Resolution and NHS England. Weighting of results according to PCB and PVB rates was performed in a manner similar to the sensitivity analysis of PCB v PVB (without accounting for LCFH) performed by the National Institute for Health and Care Excellence (NICE) in 2011 RESULTS: Additional costs of LCFH resulted in revised costs of £4,245 and £5,030 for PCB and PVB respectively – a cost advantage of £785 per delivery in favour of PCB. CONCLUSION: Providers should not be discouraged from offering or women refused PCB on grounds of cost.

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