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OptiBIRTH: a cluster randomised trial of acomplex intervention to increase vaginalbirth after caesarean section
Queen’s University Belfast, Belfast, Northern Ireland, UK.
National University of Ireland Galway, Galway, Ireland.
Hannover Medical School, Hannover, Germany.
Universtià degli Studi di Genova, Genoa, Italy.
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2020 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393Article in journal (Refereed) Published
Abstract [en]

Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are lowin many countries.

Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC ratesthrough an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland andItaly. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education ofclinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review,and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annualhospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940women.

Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was nostatistically significant difference in the change in the proportion of women having a VBAC between interventionsites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences betweenintervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI:0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited womenwith birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.

Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS inmultiparous women, interventions that are feasible and safe and that have been shown to lead to decreasingrepeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. Thismay best be done using an implementation science approach that can modify evidence-based interventions inresponse to changing clinical circumstances.Trial registration: The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.

Place, publisher, year, edition, pages
2020.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hb:diva-23257DOI: 10.1186/s12884-020-2829-yISI: 000519036500004Scopus ID: 2-s2.0-85081284525OAI: oai:DiVA.org:hb-23257DiVA, id: diva2:1436883
Projects
OptiBIRTH
Funder
EU, FP7, Seventh Framework ProgrammeAvailable from: 2020-06-08 Created: 2020-06-08 Last updated: 2021-10-21Bibliographically approved

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