Recumbent Versus Upright Positioning During Labor With an Epidural: A Cost-Effectiveness Analysis [13D]

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 133 Suppl 1; no. 1; pp. 45S - 44S
• Main Authors: Packer, Claire, Hersh, Alyssa R, Greiner, Karen S, Gallagher, Alexandra, Caughey, Aaron B
• Format: Journal Article
• Language: English
• Published: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.05.2019
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/01.AOG.0000558969.29397.24

INTRODUCTION:A recent study, the BUMPES trial, found that recumbent positioning in labor for women with a low-dose epidural resulted in decreased time (minutes) of the second stage of labor and an increased number of spontaneous vaginal deliveries. We sought to examine the cost-effectiveness and outcomes associated with laboring upright versus recumbent position during the first delivery and its effect on the subsequent pregnancy. METHODS:We designed a cost-effectiveness model using TreeAge software comparing outcomes in women with a low-dose epidural who underwent labor in upright versus a recumbent position. We used a theoretical cohort of 1.1 million women. Outcomes included mode of delivery and maternal death in the index pregnancy, and mode of delivery, maternal death, uterine rupture and hysterectomy in the subsequent pregnancy. We measured cost and quality-adjusted life years (QALY) for both pregnancies. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. RESULTS:We found that women using low-dose epidural anesthesia laboring in the recumbent position during her first labor resulted in fewer cesarean deliveries and reduced costs and improved QALYs for the first and subsequent deliveries. In our theoretical cohort, laboring in the recumbent position led to 38,190 fewer cesarean deliveries, 11 fewer maternal deaths, 66 fewer uterine ruptures, and 18 fewer hysterectomies, saving $165 million with 231,000 increased QALYs across both pregnancies (Table 1). CONCLUSION:Laboring in a recumbent position with a low-dose epidural is a no-cost intervention that leads to improved outcomes, decreased costs and increased QALYs during the first and second delivery.