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Evaluation of an intervention to increase vaginal birth after caesarean section through enhanced women-centred care: The OptiBIRTH randomised trial (ISRCTN10612254)

Konferensbidrag (offentliggjort, men ej förlagsutgivet)
Författare Cecily Begley
Mike Clarke
Declan Devane
Mechthild Gross
Sandra Morano
Ingela Lundgren
Marlene Sinclair
Koen Putman
Beverly Beech
Katri Vehvilainen-Julkunen
Marianne Nieuwenhuijze
Hugh Wiseman
Valerie Smith
Deirdre Daly
Gerard Savage
John Newell
Susanne Grylka-Baeschlin
Patricia Healy
Jane Nicoletti
Joan Lalor
Margaret Carroll
Evelien Van Limbeek
Christina Nilsson
Janine Stockdale
Maaike Fobelets
Publicerad i 31th ICM Triennial Congress
Publiceringsår 2017
Publicerad vid Institutionen för vårdvetenskap och hälsa
Språk en
Länkar www.icm2017.com/abstract_summary.ph...
Ämneskategorier Annan hälsovetenskap, Reproduktiv och perinatal omvårdnad, Omvårdnad

Sammanfattning

Background: Vaginal birth after a previous caesarean (VBAC) is a safe alternative to repeat caesarean section (CS), is the preferred option of most women and may reduce overall CS rates.1 However, VBAC rates vary; e.g., rates in Germany, Ireland and Italy are considerably lower (29-36%) than those in the Netherlands, Sweden and Finland (45-55%). Purpose/Objective: To evaluate the effectiveness of an intervention to maximise VBAC rates. The OptiBIRTH Project was funded by a European Union Grant: FP7-HEALTH-2012-INNOVATION-1-HEALTH.2012.3.2-1. Agreement No:305208 Method: A cluster randomised trial was used. A sample size of 12 maternity units was required, each recruiting 120 consenting women, to detect an absolute 15% difference in successful VBACs (increase from 25% in control to 40% in intervention groups), using an ICC of 0.05, with power of >80% and an alpha of 0.05. To allow for loss to follow-up, 15 trial units were randomised across three countries with low VBAC rates (Germany, Ireland and Italy) and the trial commenced April 2014. An evidence-based intervention was introduced in all intervention sites. Control sites had usual care. Interim analysis by an independent Data Monitoring Committee at mid-point permitted continuation. Data were analysed using intention to treat. Key Findings: Recruitment closed October 2015, with the last babies born in December 2015, and data analysis will be completed in April 2016. The primary outcome, comparison of annual VBAC rates for each hospital before and after introduction of the intervention will be presented, and selected secondary outcomes for the recruited women including: mode of birth, perineal trauma, breastfeeding, uterine rupture, wound breakdown, perinatal mortality, Apgar scores, and admission to neonatal intensive care unit. Discussion: If the OptiBIRTH intervention increases VBAC rates safely, its introduction across Europe could prevent 160,000 unnecessary CSs every year, saving maternity services >€150 million annually and contributing to the normalisation of birth for thousands of women. References: 1 Cunningham et al (2010). National Institute of Health Consensus Development Conference Statement: Vaginal birth after caesarean. Obstet & Gynecol 115(6): 1279-1295. 2 EURO-PERISTAT 2008: CD006066.EURO-PERISTAT Project (2008). European Perinatal Health Report. (www.europeristat.com).

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