Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study.
Adult
Cesarean Section, Repeat
/ standards
Clinical Decision Rules
Female
Healthcare Disparities
/ standards
Humans
Logistic Models
Netherlands
Practice Guidelines as Topic
Practice Patterns, Physicians'
/ standards
Pregnancy
Prospective Studies
Retrospective Studies
Trial of Labor
Vaginal Birth after Cesarean
/ adverse effects
cesarean delivery
decision aid
practice variation
trial of labor
vaginal birth after cesarean
Journal
Journal of perinatal medicine
ISSN: 1619-3997
Titre abrégé: J Perinat Med
Pays: Germany
ID NLM: 0361031
Informations de publication
Date de publication:
27 Sep 2021
27 Sep 2021
Historique:
received:
07
01
2021
accepted:
26
04
2021
pubmed:
29
5
2021
medline:
27
1
2022
entrez:
28
5
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 34049425
pii: jpm-2021-0007
doi: 10.1515/jpm-2021-0007
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
783-790Informations de copyright
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
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