Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial

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dc.contributor.authorVlemmix, F.
dc.contributor.authorRosman, A.
dc.contributor.authorRijnders, M.
dc.contributor.authorBeuckens, A.
dc.contributor.authorOpmeer, B.
dc.contributor.authorMol, B.
dc.contributor.authorKok, M.
dc.contributor.authorFleuren, M.
dc.date.issued2015
dc.description.abstractOBJECTIVE. To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. DESIGN. Cluster randomized controlled trial. SETTTING. Twenty-five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. POPULATION. Singleton breech presentation from 32 weeks of gestation onwards. METHODS. We randomized clusters to a client strategy (written information leaf- lets and decision aid), a care-provider strategy (1-day counseling course focused on knowledge and counseling skills), a combined client and care- provider strategy and care-as-usual strategy. We performed an intention- to-treat analysis. MAIN OUTCOME MEASURES. Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. RESULTS. The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8 – 95%. Neither the client strategy (OR 0.8, 95% CI 0.4 – 1.5) nor the care-provider strategy (OR 1.2, 95% CI 0.6 – 2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3 – 1.4 and OR 2.0, 95% CI 0.7 – 4.5). CONCLUSIONS. Neither a client nor a care- provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure
dc.description.statementofresponsibilityFloortje Vlemmix, Ageeth N. Rosman, Marlies E. Rijnders, Antje Beuckens, Brent C. Opmeer, Ben W.J. Mol, Marjolein Kok, & Margot A.H. Fleuren
dc.identifier.citationActa Obstetricia et Gynecologica Scandinavica, 2015; 94(5):518-526
dc.identifier.doi10.1111/aogs.12609
dc.identifier.issn0001-6349
dc.identifier.issn1600-0412
dc.identifier.orcidMol, B. [0000-0001-6887-0262] [0000-0001-8337-550X]
dc.identifier.urihttp://hdl.handle.net/2440/91628
dc.language.isoen
dc.publisherWiley-Blackwell Publishing
dc.rights© 2015 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavic
dc.source.urihttps://doi.org/10.1111/aogs.12609
dc.subjectBreech delivery; breech presentation; external cephalic version; implementation; mode of delivery
dc.titleImplementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial
dc.typeJournal article
pubs.publication-statusPublished

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