title: Implementation of external cephalic version in the Netherlands: a retrospective cohort study.
abstract: BACKGROUND
  External cephalic version (ECV) reduces the rate of elective cesarean sections as a result of breech presentation. Several studies have shown that not all eligible women undergo an ECV attempt. The aim of this study was to evaluate the implementation of ECV in the Netherlands and to explain variation in implementation rates with hospital characteristics and individual factors.
  
  
  METHODS
  We invited 40 hospitals to participate in this retrospective cohort study. We reviewed hospital charts for all singleton breech deliveries from 36 weeks' gestation and onwards between January 2008 and December 2009. We documented whether an ECV attempt was performed, reasons for not performing an attempt, mode of delivery, and hospital characteristics.
  
  
  RESULTS
  We included 4,770 women from 36 hospitals. ECV was performed in 2,443 women (62.2% of eligible women, range 8.2-83.6% in different hospitals). Implementation rates were higher in teaching hospitals, hospitals with special office hours for ECV, larger obstetric units, and hospitals located in larger cities. Suboptimal implementation was mainly caused by health care providers who did not offer ECV.
  
  
  CONCLUSIONS
  ECV implementation rates vary widely among hospitals. Suboptimal implementation is mostly caused by the care provider not offering the treatment and secondly due to women not opting for the offered attempt. A prerequisite for designing a proper implementation strategy is a detailed understanding of the exact reasons for not offering and not opting for ECV.
authors.affiliation: Department of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, the Netherlands.
authors.forename: Floortje
authors.initials: F
authors.lastname: Vlemmix
authors.forename: Ageeth N
authors.initials: AN
authors.lastname: Rosman
authors.forename: Susan
authors.initials: S
authors.lastname: te Hoven
authors.forename: Suzanne
authors.initials: S
authors.lastname: van de Berg
authors.forename: Margot A H
authors.initials: MA
authors.lastname: Fleuren
authors.forename: Marlies E
authors.initials: ME
authors.lastname: Rijnders
authors.forename: Antje
authors.initials: A
authors.lastname: Beuckens
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Marjolein
authors.initials: M
authors.lastname: Kok
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000628:therapy*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D014710:Version, Fetal / Q000706:statistics & numerical data*
keywords: breech; external cephalic version; implementation