title: Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Dutch Trial Register (NTR): 1878.
authors.affiliation: Department of Gynaecology and Obstetrics, Academic Medical Centre, Amsterdam, the Netherlands. f.vlemmix@gmail.com
authors.forename: Floortje
authors.initials: F
authors.lastname: Vlemmix
authors.forename: Ageeth N
authors.initials: AN
authors.lastname: Rosman
authors.forename: Margot A H
authors.initials: MA
authors.lastname: Fleuren
authors.forename: Marlies E B
authors.initials: ME
authors.lastname: Rijnders
authors.forename: Antje
authors.initials: A
authors.lastname: Beuckens
authors.forename: Monique C
authors.initials: MC
authors.lastname: Haak
authors.forename: Bettina M C
authors.initials: BM
authors.lastname: Akerboom
authors.forename: Joke M J
authors.initials: JM
authors.lastname: Bais
authors.forename: Simone M I
authors.initials: SM
authors.lastname: Kuppens
authors.forename: Dimitri N
authors.initials: DN
authors.lastname: Papatsonis
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Joris A M
authors.initials: JA
authors.lastname: van der Post
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kok
mesh_terms: D001946:Breech Presentation / Q000453:epidemiology / Q000628:therapy*; D002585:Cesarean Section / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D009721:Nurse Midwives / Q000193:education / Q000458:organization & administration; D009774:Obstetrics / Q000193:education / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011247:Pregnancy; D012107:Research Design; D014710:Version, Fetal / Q000193:education / Q000706:statistics & numerical data
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