Term delivery after hospitalization for preterm labor: incidence and costs in california |
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| Affiliation: | 1. Department of Obstetrics, Gynecology and Reproductive Sciences, and Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA;1. Third Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece;2. Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham, United Kingdom;3. Institute of Medical Sciences, Canterbury Christ Church University, Chatham, United Kingdom;4. Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Fetal Medicine Unit, Madrid, Spain;5. Obstetrics and Gynecology Department, St. Joseph University Hotel-Dieu de France University Hospital, Beirut, Lebanon;6. Obstetrics and Gynecology Department, Bellevue Medical Center, Beirut, Lebanon;7. Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, Helsinki 00290, Finland;8. Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Spain;9. Department of Neonatology, University Children’s Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany;10. Department of Pediatrics, Kyorin University, Tokyo, Japan;11. Department of Neonatology, University Hospital of Obstetrics and Gynecology “Maichin dom”, Medical University, Sofia, Bulgaria;12. Department of Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy;13. Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria di Parma Fetal Medicine Unit, Parma, Italy;14. Department of Fetal Medicine, Shterev Hospital, Sofia 1330, Bulgaria;15. KU Leuven, Leuven, Belgium;p. Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands;q. Department of Development and Regeneration, and Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium;r. Fetal Medicine Unit, St George''s Hospital, St George''s University of London, London, United Kingdom;s. Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George''s University of London, London, United Kingdom;t. Department of Perinatal Medicine, Obstetrics and Gynecology, Istanbul University-Cerrahpasa, and Perinatal Medicine Foundation, Istanbul, Turkey;1. Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands;2. Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, The Netherlands;3. Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia;1. Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, South Korea;2. Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Victoria, Australia;3. Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China;4. Translational Health Science and Technology Institute, National Capital Region Biotech Science Cluster, Faridabad, India;5. Department of Obstetrics & Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan;6. Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans Univeristy MokDong Hospital, Seoul, South Korea;1. Department of Women''s Health, King''s College London, St Thomas'' Hospital, London, UK;2. Centre for the Developing Brain, King''s College London, St Thomas'' Hospital, London, UK |
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| Abstract: | Objective: To determine the incidence and costs for cases of idiopathic preterm labor followed by term delivery.Study Design: Patients hospitalized with preterm labor (N = 28,845) were identified in a dataset linking antepartum and delivery discharge abstracts of all women in California (N = 404,466) with a delivery related diagnosis from 1/1/93 to 11/19/93. Patients with multiple gestations, PROM, abruption, placenta previa, uterine anomalies, and other morbidities were excluded, leaving 19,897 study subjects. Birth outcomes were classified as term or preterm (<37 weeks). The incidence, hospital costs, and risk factors for hospitalization for preterm labor followed by term delivery were then determined using a retrospective nested case control design. Indirect costs of subsequent bedrest were estimated using data from the California Disability Insurance Fund.Results: Thirty-four percent of patients hospitalized with idiopathic preterm labor had term deliveries accounting for 2% of the pregnant population. Eighty-one percent of patients who were discharged undelivered after hospitalization delivered at term. These patients were significantly more likely to be Caucasian, privately insured, and older than patients who delivered preterm. A minimum of 45% of cases were estimated to be false diagnoses based on the relative risk of post-dates pregnancy between patients hospitalized with preterm labor and term controls. Costs totalled $4,995 per case with $2,335 in hospital costs and $2,497 in indirect costs from an average of 4 weeks of bedrest. Statewide costs for California were estimated to range from 24 to 48 million dollars annually for these potentially avertible hospitalizations.Conclusions: Hospitalization for idiopathic preterm labor with delivery at term is common, costly, and probably due to false diagnosis in a significant proportion of cases. |
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