Vlemmix, F.Rosman, A.Rijnders, M.Beuckens, A.Opmeer, B.Mol, B.Kok, M.Fleuren, M.2015-06-012015-06-012015Acta Obstetricia et Gynecologica Scandinavica, 2015; 94(5):518-5260001-63491600-0412http://hdl.handle.net/2440/91628OBJECTIVE. 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 procedureen© 2015 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica ScandinavicBreech delivery; breech presentation; external cephalic version; implementation; mode of deliveryJournal article003002282210.1111/aogs.126090003530330000122-s2.0-84927523494173343Mol, B. [0000-0001-6887-0262] [0000-0001-8337-550X]