Conservative management of placenta previa: a cost-benefit analysis

Thirty-eight gravid patients with placenta previa were managed according to either an inpatient expectant or an outpatient expectant approach. The inpatient expectant group showed significant improvement in outcome by several measures when compared with the outpatient expectant group. These included mean obstetric gestational age at delivery (35.3 versus 32.4 weeks), mean neonatal Dubowitz (35.7 versus 33.3 weeks), mean neonatal weight (2442 versus 1824 gm), neonatal morbidity (24% versus 74%), mean neonatal hospital days (21.2 versus 32.8 days), and neonatal hospital costs (nearly a 3:1 ratio). There were two cases of neonatal death in the outpatient expectant group and none in the inpatient expectant group. Mean maternal hospital days and hospital costs were significantly higher in the inpatient expectant group. However, overall hospital costs for maternal-neonatal pairs were 69% higher in the outpatient expectant group. The implications of these findings are discussed.