An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial).

OBJECTIVE: To assess the economic consequences of labour induction compared with expectant monitoring in women with gestational hypertension or pre-eclampsia at term. DESIGN: An economic analysis alongside the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT). SETTING: Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands. POPULATION: Women diagnosed with gestational hypertension or pre-eclampsia between 36(+0) and 41(+0) weeks of gestation, randomly allocated to either induction of labour or expectant monitoring. METHODS: A trial-based cost-effectiveness analysis was performed from a societal perspective during a 1-year time horizon. MAIN OUTCOME MEASURES: One-year costs were estimated and health outcomes were expressed as the prevalence of poor maternal outcome defined as either maternal complications or progression to severe disease. RESULTS: The average costs of induction of labour (n = 377) were €7077 versus €7908 for expectant monitoring (n = 379), with an average difference of -€831 (95% CI -€1561 to -€144). This 11% difference predominantly originated from the antepartum period: per woman costs were €1259 for induction versus €2700 for expectant monitoring. During delivery, more costs were generated following induction (€2190) compared with expectant monitoring (€1210). No substantial differences were found in the postpartum, follow-up and for non-medical costs. CONCLUSION: In women with gestational hypertension or mild pre-eclampsia at term, induction of labour is less costly than expectant monitoring because of differences in resource use in the antepartum period. As the trial already demonstrated that induction of labour results in less progression to severe disease without resulting in a higher caesarean section rate, both clinical and economic consequences are in favour of induction of labour in these women. TRIAL REGISTRATION: The trial has been registered in the clinical trial register as ISRCTN08132825.

[Veterinary dental health science. 18. Chronic molar fistula in a lion: case discussion]. / Veterinaire tandheelkunde 18. Chronische kiesfistel bij een leeuwin; casusbespreking.

In this case-report immobilization, examination and treatment of a lion (Panthera leo) with a chronic fistulation of a carnassial tooth are described.

[Continuation of pregnancy in infaust fetal prognosis]. / Uitdragen van een zwangerschap bij een foetale prognose 'infaust'.

In three pregnant women, lethal anomalies of the fetus were diagnosed ultrasonographically in the second trimester. These women decided to continue their pregnancies for different reasons. One woman strongly regretted her decision to abort a previous pregnancy. The second hoped that the doctors were mistaken on the prognosis. The third woman was afraid of medical interventions. In case of lethal anomalies of the fetus, doctors should advise their patients to consider both options: termination as well as continuation of their pregnancy. Irrespective of the women's choice, doctors ought to be committed to support the pregnant women in such a troublesome situation.