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. 2010 May 10:10:20.
doi: 10.1186/1471-2393-10-20.

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

Floortje Vlemmix  1 , Ageeth N Rosman, Margot A H Fleuren, Marlies E B Rijnders, Antje Beuckens, Monique C Haak, Bettina M C Akerboom, Joke M J Bais, Simone M I Kuppens, Dimitri N Papatsonis, Brent C Opmeer, Joris A M van der Post, Ben Willem J Mol, Marjolein Kok
Affiliations

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

Floortje Vlemmix et al. BMC Pregnancy Childbirth. .

Abstract

Background: Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less.We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling.

Method/design: The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured.

Discussion: This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term.

Trial registration: Dutch Trial Register (NTR): 1878.

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References

    1. Hickok DE, Gordon DC, Milberg JA, Williams MA, Daling JR. The frequency of breech presentation by gestational age at birth: a large population-based study. Am J Obstet Gynecol. 1992;166(3):851–852. - PubMed
    1. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356(9239):1375–1383. doi: 10.1016/S0140-6736(00)02840-3. - DOI - PubMed
    1. Rietberg CC, Elferink-Stinkens PM, Brand R, van Loon AJ, Van Hemel OJ, Visser GH. Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants. BJOG. 2003;110(6):604–609. doi: 10.1046/j.1471-0528.2003.01507.x. - DOI - PubMed
    1. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356(9239):1375–1383. doi: 10.1016/S0140-6736(00)02840-3. - DOI - PubMed
    1. Kwee A, Smink M, Van Der Laar R, Bruinse HW. Outcome of subsequent delivery after a previous early preterm cesarean section. J Matern Fetal Neonatal Med. 2007;20(1):33–37. doi: 10.1080/14767050601036527. - DOI - PubMed

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