Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review

Melman, Sonja; Schoorel, Ellen C. N.; Boer, Karin; Burggraaf, Henriëtte; Derks, Jan; Dijk, Det van; Dillen, Jeroen van; Dirksen, Carmen D.; Duvekot, Johannes J.; Franx, Arie; Hasaart, T. H. M.; Huisjes, Anjoke; Kolkman, Diny G.E.; Kuijk, Sander M. J. van; Kwee, Anneke; Mol, Ben Willem J.; Pampus, Maria G. van; Roon-Immerzeel, Alieke de; Roosmalen, J.J.M. van; Roumen, Frans J.M.E.; Smid-Koopman, E.; Smits, Luc; Spaans, Wilbert; Visser, Harry; Wijngaarden, Wim J. van; Willekes, Christine; Wouters, M.G.A.J.; Nijhuis, Jan G.; Hermens, Rosella; Scheepers, Hubertina C.J.

doi:10.1371/journal.pone.0145771

Cited by 14 publications

(21 citation statements)

References 27 publications

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“…In the CS implementation study (SIMPLE), a RAND-modified Delphi procedure resulted in 27 quality indicators describing optimal CS care based on international guidelines and literature [13]. The adherence to CS quality indicators was measured in 21 hospitals in The Netherlands in order to gain insight into current obstetrical care.…”

Section: Introductionmentioning

confidence: 99%

Identification of barriers and facilitators for optimal cesarean section care: perspective of professionals

Melman

Schreurs

Dirksen

et al. 2017

BMC Pregnancy Childbirth

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BackgroundThe cesarean section (CS) rate has increased over recent decades with poor guideline adherence as a possible cause. The objective of this study was to explore barriers and facilitators for delivering optimal care as described in clinical practice guidelines.MethodsKey recommendations from evidence-based guidelines were used as a base to explore barriers and facilitators for delivering optimal CS care in The Netherlands. Both focus group and telephone interviews among 29 different obstetrical professionals were performed. Transcripts from the interviews were analysed. Barriers and facilitators were identified and categorised in six domains according to the framework developed by Grol: the guideline recommendations (I), the professional (II), the patient (III), the social context (IV), the organizational context (V) and the financial/legislation context (VI).ResultsMost barriers were found in the professional and organizational domain. Barriers mentioned by healthcare professionals were disagreement with specific guideline recommendations, and hesitation to allow women to be part of the decision making process. Other barriers are lack of adequately trained personal staff, lack of collaboration between professionals, and lack of technical equipment.ConclusionsClear facilitators and barriers for guideline adherence were identified in all domains. Several barriers may be addressed by using decision aids on mode of birth or prediction models to individualise care in women in whom both planned vaginal birth and CS are equal options. In women with an intended vaginal birth, adequate staffing and the availability of both fetal blood sampling and epidural analgesia are important.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1416-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Identification of barriers and facilitators for optimal cesarean section care: perspective of professionals

Melman

Schreurs

Dirksen

et al. 2017

BMC Pregnancy Childbirth

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“…The study was a consecutive study of the previously reported SIMPLE study [8]. The study was initially designed as a controlled before and after study with an intervention trial incorporated in the second part.…”

Section: Methodsmentioning

confidence: 99%

“…In 2015, 1.3 million women in the US underwent a CS (32%) [6], making it one of the most frequently performed operative interventions in women. In The Netherlands, VBAC rates are much higher (54%) [7], but most women are inadequately informed about their choices due to caregivers’ fear of an increase in CS rates [8]. Morbidity risks (both maternal and neonatal) are directly related to the individual probability of VBAC since morbidity is lowest in women with VBAC, but higher in women with unplanned than planned CS [9].…”

Section: Introductionmentioning

confidence: 99%

The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section: A prospective cohort study

et al. 2019

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ObjectiveAfter one previous caesarean section (CS), pregnant women can deliver by elective repeat CS or have a trial of labor which can end in a vaginal birth after caesarean (VBAC) or an unplanned CS. Despite guidelines describing women’s rights to make an informed choice, trial of labor and VBAC rates vary greatly worldwide. Many women are inadequately informed due to caregivers’ fear of an increase in CS rates in a high VBAC rate setting. We compared counseling with a decision aid (DA) including a prediction model on VBAC to care as usual. We hypothesize that counselling with the DA does not decrease VBAC rates. In addition, we aimed to study the effects on unplanned CS rate, patient involvement in decision-making and elective repeat CS rates.MethodsWe performed a prospective cohort study. From 2012 to 2014, 483 women in six hospitals, where the DA was used (intervention group), were compared with 441 women in six matched hospitals (control group). Women with one previous CS, pregnant of a singleton in cephalic presentation, delivering after 37 weeks 0 days were eligible for inclusion.ResultsThere was no significant difference in VBAC rates between the intervention (45%) and control group (46%) (adjusted odds ratio 0,92 (95% Confidence interval 0.69–1.23)). In the intervention group more women (42%) chose an elective repeat CS compared to the control group (31%) (adjusted odds ratio 1.6 (95% Confidence interval 1.18–2.17)). Of women choosing trial of labor, in the intervention group 77% delivered vaginally compared to 67% in the control group, resulting in an unplanned CS adjusted odds ratio of 0,57 (0.40–0.82) in the intervention group. In the intervention group, more women reported to be involved in decision-making (98% vs. 68%, P< 0.001).ConclusionsImplementing a decision aid with a prediction model for risk selection suggests unchanged VBAC rates, but 40% reduction in unplanned CS rates, increase in elective repeat CS and improved patient involvement in decision-making.

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“…If we implement a standardized system where labor outcomes are included, we may more easily recognize events and adverse outcomes in the delivery ward 264,317,318 . An improvement of the use of TGCS as a standardized system including labor outcomes was introduced in Paper II.…”

Section: Systems and Standardizationmentioning

confidence: 99%

“…Oxytocin augmentation has thereby gained focus, and awareness has been raised. It is believed that such projects will contribute to increased quality of labor management 317 . In the meantime, obstetricians and midwives should collaborate and improve the available assessment tools 293,320 .…”

Section: Systems and Standardizationmentioning

confidence: 99%

Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

Rossen

Klungsøyr

Albrechtsen

et al. 2018

Acta Obstet Gynecol Scand

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Printed by NTNU Grafisk senter Stimulering av rier med oxytocin og sammenheng med fødselsutfallOxytocin blir ofte brukt under fødselen for å øke styrken på riene. Mangel på klare indikasjoner for bruk av oxytocin har ført til ulik praksis og tilfeldig bruk. Hensikten med studien var å undersøke om det kan vaere en sammenheng mellom bruken av oxytocin og hvordan fødselen blir for kvinnen og for barnet. Studie I Vi undersøkte retrospektivt risikofaktorer for blødning over 1000 ml etter fødselen og om dette hadde endret seg fra 1998 til 2007. Blødning over 1000 ml økte i studieperioden og risikoen var dobbelt så stor etter keisersnitt sammenlignet med vaginal fødsel (2.8 % vs. 5.9 %). Igangsetting av fødsel, stimulering av rier og keisersnittfrekvens økte, og disse faktorene viste sammenheng med alvorlig blødning etter fødselen. Bruk av oxytocin for stimulering av rier økte fra 5.8 % til 29.3 %. Studie II Målet med denne studien var å presentere en metode for å evaluere og kvalitetssikre utfall og hendelser for mor og barn i forbindelse med fødsel. Michael Robson har laget en metode der fødende kvinner kan klassifiseres i ti ulike grupper. Metoden ble først utviklet for å klassifisere bruken av keisersnitt. I denne studien presenterer vi hvordan vi kan klassifisere 16 fødselsutfall i henhold til de ti gruppene. Vi presenterer resultater fra fødeavdelinger i Stavanger, Dublin og nasjonale data fra Slovenia. Studie III Fødeavdelingen ved Stavanger universitetssjukehus endret indikasjonene og rutinene for oxytocinbruk i 2010. I løpet av en 5 års periode ble bruken av oxytocin under fødselen signifikant redusert fra 35.5 % til 23.6 %. Antall akutte keisersnitt og antall barn med lav pH i navlesnora gikk ned i samme tidsperiode og vi diskuterer om dette kan ha en sammenheng med redusert bruk av oxytocin. Flere kvinner opplevde blødning over 1000ml og varighet av fødsel over 12 timer. Studie IV Fødselsregistrene i Norge og Danmark ble brukt for å undersøke bruken av oxytocin for ristimulering hos førstegangsfødende kvinner med spontan fødselstart til termin. Vi fant at bruk av oxytocin økte med kvinnenes alder, bruk av epiduralbedøvelse og med akutte keisersnitt. Formålet med studien var å vurdere samspillet mellom disse faktorene. Ristimulering viste sammenheng med lavere forekomst av keisersnitt hos kvinner med epiduralbedøvelse, spesielt hos kvinner over 35 år. Konklusjon Målrettet bruk av oxytocin for stimulering av rier førte til redusert bruk av oxytocin og viste sammenheng med faerre akutte keisersnitt og faerre barn med lav pH i navlesnora. Kvinner med epiduralbedøvelse kan imidlertid ha fordel av ristimulering. Flere ulike faktorer har innvirkning på fødselsforløp og fordeler og ulemper må vurderes i forhold til hverandre. Robsons 10-gruppe klassifikasjonssystem kan vaere et nyttig hjelpemiddel for å kvalitetssikre fødselsutfall og for å sammenligne ulike fødeavdelinger. Kristiansand, fredag 16.juni 2017 kl.12.15

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Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review

Cited by 14 publications

References 27 publications

Identification of barriers and facilitators for optimal cesarean section care: perspective of professionals

Identification of barriers and facilitators for optimal cesarean section care: perspective of professionals

The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section: A prospective cohort study

Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

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