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- Title
Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial.
- Authors
Vlemmix, Floortje; Rosman, Ageeth N.; Rijnders, Marlies E.; Beuckens, Antje; Opmeer, Brent C.; Mol, Ben W.J.; Kok, Marjolein; Fleuren, Margot A.H.
- Abstract
Objective To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. Design Cluster randomized controlled trial. Setting 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 leaflets 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.
- Subjects
RANDOMIZED controlled trials; BREECH delivery; PREGNANCY; DELIVERY (Obstetrics); MIDWIFERY
- Publication
Acta Obstetricia et Gynecologica Scandinavica, 2015, Vol 94, Issue 5, p518
- ISSN
0001-6349
- Publication type
Article
- DOI
10.1111/aogs.12609