(340) Fetal Scalp pH Sampling with EFM vs. EFM Alone: A two-delivery cost-effectiveness analysis

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Historically, fetal scalp pH sampling (FSC) was used as a tool to determine fetal wellbeing during labor when the electronic fetal monitoring (EFM) was uncertain. About twenty years ago, this practice was discontinued in the United States, but remains standard in European countries. We studied the cost-effectiveness and outcomes associated with the addition of FSC to EFM for nulliparous individuals with category II tracings.

Study Design: We performed a cost-effectiveness analysis to compare outcomes with FSC and EFM compared to EFM alone. We used a theoretical cohort of 1 million pregnant individuals, the approximate number of nulliparous individuals with category II tracings in the US per year. We considered these to be otherwise uncomplicated deliveries. We examined outcomes in the index pregnancy as well as the subsequent pregnancy. The cost of FSC was $115. Outcomes were combined for both deliveries and included costs and quality-adjusted life years (QALYs), cesarean delivery, maternal death, uterine rupture, and hysterectomy. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Sensitivity analysis was used to further assess the results.

Results: The addition of FSC with EFM resulted in fewer cesarean deliveries, reduced costs, and improved QALYs for both the first and subsequent delivery. Among 1 million individuals, FSC led to 99,018 fewer cesarean deliveries, 22 fewer maternal deaths, 153 fewer uterine ruptures, and 40 fewer hysterectomies, saving $348 million with 3,983 increased QALYs (Table 1). Univariable analysis found that FSC with EFM in the first delivery is cost-saving until FSC costs greater than $440 (Figure 1).

Conclusion: FSC in addition to EFM is associated with fewer cesarean deliveries in both the first and second pregnancies, decreased costs, and increased QALYs. Our results suggest that providers should consider incorporating FSC into standard labor management.

Primary & Presenting Author(s)

Sarina R. Chaiken, BA (she/her/hers)
Medical Student
Oregon Health and Science University
Portland, Oregon, United States

Coauthor(s)
UD
Uma Doshi, BS (she/her/hers)
Medical Student
Oregon Health and Science University
Portland, Oregon, United States

Megha Arora, BS
MD-MPH Candidate
Oregon Health and Science University
Portland, Oregon, United States

Aaron B. Caughey, MD,MPH,PhD
Professor and Chair
Oregon Health and Science University
Portland, Oregon, United States