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

Floortje Vlemmix, 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

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

LanguageEnglish
Article number20
JournalBMC Pregnancy and Childbirth
Volume10
DOIs
Publication statusPublished - 10 May 2010

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Vlemmix, Floortje ; Rosman, Ageeth N. ; Fleuren, Margot A H ; Rijnders, Marlies E B ; Beuckens, Antje ; Haak, Monique C. ; Akerboom, Bettina M C ; Bais, Joke M J ; Kuppens, Simone M I ; Papatsonis, Dimitri N. ; Opmeer, Brent C. ; van der Post, Joris A M ; Mol, Ben Willem J ; Kok, Marjolein. / Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version. In: BMC Pregnancy and Childbirth. 2010 ; Vol. 10.
@article{0f5d4dbba40c4ca0b0287cbfbe3e3c8e,
title = "Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version",
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.",
author = "Floortje Vlemmix and Rosman, {Ageeth N.} and Fleuren, {Margot A H} and Rijnders, {Marlies E B} and Antje Beuckens and Haak, {Monique C.} and Akerboom, {Bettina M C} and Bais, {Joke M J} and Kuppens, {Simone M I} and Papatsonis, {Dimitri N.} and Opmeer, {Brent C.} and {van der Post}, {Joris A M} and Mol, {Ben Willem J} and Marjolein Kok",
year = "2010",
month = "5",
day = "10",
doi = "10.1186/1471-2393-10-20",
language = "English",
volume = "10",
journal = "BMC Pregnancy and Childbirth",
issn = "1471-2393",
publisher = "BioMed Central",

}

Vlemmix, F, Rosman, AN, Fleuren, MAH, Rijnders, MEB, Beuckens, A, Haak, MC, Akerboom, BMC, Bais, JMJ, Kuppens, SMI, Papatsonis, DN, Opmeer, BC, van der Post, JAM, Mol, BWJ & Kok, M 2010, 'Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version', BMC Pregnancy and Childbirth, vol. 10, 20. https://doi.org/10.1186/1471-2393-10-20

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version. / Vlemmix, Floortje; Rosman, Ageeth N.; Fleuren, Margot A H; Rijnders, Marlies E B; Beuckens, Antje; Haak, Monique C.; Akerboom, Bettina M C; Bais, Joke M J; Kuppens, Simone M I; Papatsonis, Dimitri N.; Opmeer, Brent C.; van der Post, Joris A M; Mol, Ben Willem J; Kok, Marjolein.

In: BMC Pregnancy and Childbirth, Vol. 10, 20, 10.05.2010.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

AU - Vlemmix, Floortje

AU - Rosman, Ageeth N.

AU - Fleuren, Margot A H

AU - Rijnders, Marlies E B

AU - Beuckens, Antje

AU - Haak, Monique C.

AU - Akerboom, Bettina M C

AU - Bais, Joke M J

AU - Kuppens, Simone M I

AU - Papatsonis, Dimitri N.

AU - Opmeer, Brent C.

AU - van der Post, Joris A M

AU - Mol, Ben Willem J

AU - Kok, Marjolein

PY - 2010/5/10

Y1 - 2010/5/10

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=77953673451&partnerID=8YFLogxK

U2 - 10.1186/1471-2393-10-20

DO - 10.1186/1471-2393-10-20

M3 - Article

VL - 10

JO - BMC Pregnancy and Childbirth

T2 - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

SN - 1471-2393

M1 - 20

ER -