Murat SÖNMEZER, Hülya OLMUŞ, Yavuz Emre ŞÜKÜR, Cem Somer ATABEKOĞLU, Vugar BAYRAMOV, Tuncay YÜCE, Batuhan ÖZMEN

Mode of delivery and birth complications in fetal macrosomia: a simple cost-eff ectiveness analysis

Amaç: Fetal makrozomide (>4000 g) doğum şeklinin komplikasyonlar ve bağıntılı maliyet üzerine etkisi araştırıldı. Yöntem ve gereç: 365 makrozomik doğum (≥4000 g) bilgileri retrospektif olarak değerlendirilmiştir. Bu hastaların 189’unun 4000-4249 g arasında (Grup I) ve 176’sının ise 4250-4500 g arasında (Grup II) doğum yaptığı anlaşılmıştır. Doğum şeklinin doğum komplikasyonları üzerine olan etkileri değerlendirilmiş ve basit bir maliyet analizi yapılmıştır. Bulgular: Komplikasyon oranları açısından, distosi ve epizyotomi hematomu haricinde her iki grup arasında istatiksel anlamlı bir fark izlenmemiştir. Distosi oranı Grup II’de Grup I’e nazaran belirgin olarak daha yüksek saptanmıştır (% 14,1 ve % 3,8, P = 0,040). Benzer olarak, epizyotomi hematomu oranları da Grup II’de Grup I’e göre belirgin şekilde daha yüksek bulunmuştur (% 18,8 ve % 3,8, P = 0,004). Benzer kalıcı ve ciddi komplikasyon oranlarının aksine, 4250 gr üzerinde gerçekleşen doğumlarda hafi f veya orta düzeydeki geçici maternal ve fetal komplikasyon oranları vajinal yolla doğumda yapan kadınlarda daha yüksek tespit edilmiştir (P = 0,001 ve P = 0,024). Hasta başına toplam maliyet, sezaryen operasyonunda vajinal doğumun neredeyse 2 katından daha yüksek olarak hesaplanmıştır (937 TL/hasta ve 491 TL/hasta). Sonuç: Fötal doğum ağırlığı 4250-4500 g arasında bulunan hastalarda sezaryen maliyet-etkin bir doğum şekli olmayıp, daha olumlu maternal veya yenidoğan sonuçları ile ilişkili değildi

Fetal makrozomide doğum şekli ve komplikasyonlar: Basit maliyet-etkinlik analizi

Aim: To evaluate the eff ect of delivery route on birth complications and related costs in fetal macrosomia (>4000 g). Materials and methods: Patient and newborn hospital records of 365 macrosomic deliveries (≥4000 g) were retrospectively analyzed. Of these deliveries, 189 newborns weighed between 4000 and 4249 g (Group I), and 176 were between 4250 and 4500 g (Group II). Th e eff ects of mode of delivery on birth complications were evaluated and a simple cost-eff ectiveness analysis was performed. Results: Th ere was no statistical diff erence between the 2 groups concerning birth complications, except dystocia and episiotomy hematoma. Th e rate of dystocia was found to be signifi cantly higher in Group II than in Group I (14.1% versus 3.8%, respectively; P = 0.040). Similarly, episiotomy hematoma was found to be signifi cantly higher in Group II than in Group I (18.8% versus 3.8%, respectively; P = 0.004). As opposed to similar rates of serious and permanent complications, mild or moderate temporary maternal and fetal complications were seen to be higher in vaginal births of infants weighing more than 4250 g (P = 0.001 and P = 0.024, respectively). In macrosomia, the total cost of a cesarean section (C/S) was almost 2 times higher than the cost of a vaginal delivery per patient (937 Turkish liras versus 491 Turkish liras, respectively). Conclusion: C/S was not related with favorable maternal or newborn outcomes, and it was not a cost-eff ective option in patients with fetal birth weights between 4250 and 4500 g.

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