Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study.

Autor:	Koppes DM; Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.; Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands., van Hees MSF; Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.; Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands., Koenders VM; Department of neonatology, Isala Kliniek Zwolle, Zwolle, The Netherlands., Oudijk MA; Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands., Bekker MN; Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands., Franssen MTM; Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands., Smits LJ; Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands., Hermens R; Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands., van Kuijk SMJ; Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands., Scheepers HC; Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of perinatal medicine [J Perinat Med] 2021 May 31; Vol. 49 (7), pp. 783-790. Date of Electronic Publication: 2021 May 31 (Print Publication: 2021).
DOI:	10.1515/jpm-2021-0007
Abstrakt:	Objectives: Woman with a history of a previous cesarean section (CS) can choose between an elective repeat CS (ERCS) and a trial of labor (TOL), which can end in a vaginal birth after cesarean (VBAC) or an unplanned CS. Guidelines describe women's rights to make an informed decision between an ERCS or a TOL. However, the rates of TOL and vaginal birth after CS varies greatly between and within countries. The objective of this study is to asses nation-wide implementation of counselling with a decision aid (DA) including a prediction model, on intended delivery compared to care as usual. We hypothesize that this may result in a reduction in practice variation without an increase in cesarean rates or complications. Methods: In a multicenter controlled before and after cohort study we evaluate the effect of nation-wide implementation of a DA. Practice variation was defined as the standard deviation (SD) of TOL percentages. Results: A total of 27 hospitals and 1,364 women were included. A significant decrease was found in practice variation (SD TOL rates: 0.17 control group vs. 0.10 intervention group following decision aid implementation, p=0.011). There was no significant difference in the ERCS rate or overall CS rates. A 21% reduction in the combined maternal and perinatal adverse outcomes was seen. Conclusions: Nationwide implementation of the DA showed a significant reduction in practice variation without an increase in the rate of cesarean section or complications, suggesting an improvement in equality of care. (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)
Databáze:	MEDLINE
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