No abstract

The double balloon is a successful, minimally invasive and well-tolerated single treatment for cervical pregnancy and cesarean scar pregnancy. This simple treatment method has 4 main advantages: it effectively stops embryonic cardiac activity, prevents bleeding complications, does not require any additional invasive therapies, and is familiar to obstetricians-gynecologists who use the same cervical ripening catheters for labor induction. Its wider application, however, has to be validated on a larger patient population.

(Abstracted from Am J Obstet Gynecol 2016;215:351.e1–351.e8) The occurrence of cesarean scar pregnancy and cervical pregnancy, unrelated forms of pathological pregnancies, present significant diagnostic and treatment challenges. A large number of treatments have been used with widely varying effectiveness and complication rates ranging from 10% to 62%.

We appreciate the interest by Skotko et al in our analysis for children with significant genetic conditions of economic costs resulting in part from a significant shift in utilization from diagnostic testing procedures to reliance upon cell free fetal DNA (cffDNA). 1 They believe that costs for the care of children with Down syndrome (DS) are lower than the $1 million we used from generally accepted literature and insurance company estimates (not published) as a baseline. 2,3 We compared the costs for numerous, serious disorders that can now be readily found