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Type: Journal article
Title: Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version
Author: Vlemmix, F.
Rosman, A.
Fleuren, M.
Rijnders, M.
Beuckens, A.
Haak, M.
Akerboom, B.
Bais, J.
Kuppens, S.
Papatsonis, D.
Opmeer, B.
van der Post, J.
Mol, B.
Kok, M.
Citation: BMC Pregnancy and Childbirth, 2010; 10(20):1-6
Publisher: BioMed Central
Issue Date: 2010
ISSN: 1471-2393
Statement of
Floortje Vlemmix, Ageeth N Rosman, Margot AH Fleuren, Marlies EB Rijnders, Antje Beuckens, Monique C Haak, Bettina MC Akerboom, Joke MJ Bais, Simone MI Kuppens, Dimitri N Papatsonis, Brent C Opmeer, Joris AM van der Post, Ben Willem J Mol and Marjolein Kok
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
Keywords: Humans; Breech Presentation; Cesarean Section; Version, Fetal; Health Knowledge, Attitudes, Practice; Obstetrics; Pregnancy; Research Design; Diffusion of Innovation; Nurse Midwives; Cost-Benefit Analysis; Guideline Adherence; Netherlands; Female; Patient Education as Topic; Practice Guidelines as Topic; Practice Patterns, Nurses'; Practice Patterns, Physicians'; Outcome and Process Assessment, Health Care
Rights: © 2010 Vlemmix et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
RMID: 0020136803
DOI: 10.1186/1471-2393-10-20
Appears in Collections:Obstetrics and Gynaecology publications

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