Background. External cephalic version (ECV) may enable vaginal delivery of the breech presenting fetus. However, ECV is infrequently performed. Currently 98% of breech babies are delivered by cesarean delivery. One potential factor limiting ECV is the success rate, which may be below 50%. By using neuraxial analgesia/anesthesia this success rate can be significantly increased. We calculated the costs for ECV under spinal analgesia versus elective cesarean delivery for breech presentation.
Methods. In a tertiary hospital we costed three variables; manpower, disposables, and fixed costs for these delivery management options; ECV, ECV plus spinal analgesia, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Data for manpower were received from management payroll, for fixed costs by calculating cost/lifetime usage rate and for disposables using micro-costing of purchasing costs to our institution in 2008, 1US$=4New Israeli Shekel.
Results. Cesarean delivery was the most expensive option (8751 NIS), whereas vaginal delivery following successful ECV under spinal analgesia costs 3,941 NIS. ECV alone costs 720 NIS, ECV plus spinal analgesia costs 1040 NIS. The highest individual costs for vaginal delivery, cesarean section and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). When considering rates of ECV success with and without analgesia together with expected cesarean delivery rates, spinal plus ECV pathway is less costly due to lower expected cesarean delivery rate and its lower associated costs. A policy of spinal analgesia for ECV with successful vaginal delivery saved almost 600 NIS per delivery, Figure 1.
Conclusions. Encouraging ECV practice, with spinal analgesia for breech presenting term pregnancy has cost benefit compared with performing elective cesarean delivery for all breech presentation. Use of spinal analgesia is cost beneficial due to increased ECV success rates, reducing the expected cesarean delivery rate subsequent to ECV failure.