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Poster Session 1

Category: Operative Obstetrics

Poster Session 1

(123) Mode of delivery at 22 weeks gestational age: a cost-effectiveness analysis

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Amanda M. Baucom, MBA, MD (she/her/hers)

Maternal Fetal Medicine Fellow
University of Cincinnati
Cincinnati, Ohio, United States

Coauthor(s)

Robert M. Rossi, MD

Assistant Professor
Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine University of Cincinnati College of Medicine
Cincinnati, Ohio, United States
Clarice G. Zhou, MD (she/her/hers)

Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine
NYU Grossman School of Medicine, New York, United States
Aaron B. Caughey, MD, PhD

Chair and Professor of Obstetrics and Gynecology
Oregon Health & Science University
Oregon Health & Science University, Oregon, United States

Objective:
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) currently do not recommend emergent cesarean delivery for infants born at 22 weeks’ gestation. However, emerging data suggests potential neonatal survival benefits. Given the established maternal risks associated with emergent cesarean delivery, this study aimed to evaluate the cost-effectiveness of delivery mode at 22 weeks’ gestation, with particular emphasis on long-term reproductive outcomes.

Study Design:
A decision-analytic model was developed using TreeAge software to compare emergent cesarean versus no emergent cesarean at 22 weeks’ gestation. A theoretical cohort of 1,693 pregnant individuals was modeled based on an estimated U.S. annual incidence of 0.05% of deliveries at this gestation. Neonatal survival, neurologic outcomes, and maternal outcomes in subsequent pregnancies were evaluated in terms of costs (2025 USD) and quality-adjusted life years (QALYs) over a lifetime horizon. Model parameters were derived from literature. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, employing a willingness-to-pay threshold of $100,000/QALY.

Results:
In this theoretical model, emergent cesarean delivery at 22 weeks’ gestation resulted in 366 additional survivors compared to vaginal delivery, of whom 165 were neurologically intact. In subsequent pregnancies, prior classical cesarean delivery was associated with increased rates of placenta previa and placenta accreta spectrum. The incremental cost of emergent cesarean delivery relative to vaginal delivery was $199,880 per neonate, with an associated gain of 4.73 QALYs, resulting in an ICER of $42,258 per QALY. One-way sensitivity analysis demonstrated that emergent cesarean delivery remained cost-effective if infant survival exceeded 25.0%.

Conclusion:
These findings suggest that, under current neonatal outcome data, emergent cesarean delivery at 22 weeks’ gestation may be a cost-effective strategy compared to vaginal delivery, even when long-term implications for subsequent pregnancies are considered.