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Keuzehulp implementatie


Keuzehulp na keizersnede / patient decision aid after caesarean

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Objective
Mode of delivery after previous caesarean should ideally be discussed in a shard decision making setting. The SIMPLE II has developed a patient decision aid. In a small population they have proven that this patient decision aid leads to a higher patient satisfaction and less secondary caesareans. The goal of this  study is a national implementation of the decision aid for mode of delivery after one previous caesarean. After implementation we want to objectify if there is any change in practice.

Study design

Retrospective chart study

Study population

Women with one previous caesarean
  • Inclusion criteria
    - Pregnant women with one previous caesarean

    - Singleton pregnancy

    - Cephalic presentation

    - ≥ 37 weeks of pregnancy

  • Exclusion criteria: contraindications for a vaginal delivery
    - History of classic vertical incision of the uterus

    - History of rupture of the uterus

    - Suspicion of abruptio placentae

    - Mechanical obstruction for a vaginal delivery: cervical myoma, placenta praevia, vasa praevia

    - Primary infection with genital herpes simples or active human immunodeficiency virus.


Intervention

Counselling mode of delivery with the patient decision aid

Outcome measures
Practice variation primary caesarean
Practice variation vaginal deliveries
Practice variation secondary caesarean

Power/data analysis
In current care 69% of the women starts a vaginal delivery and 31% chooses a primary caesarean. We have the assumption that there is a dispersion between hospitals. Even when corrected for the different population of patients. We expect this dispersion to decrease after using the patient decision aid. The estimated standard deviation between hospitals for the planned caesarean is around 11% without using the decision aid. For a reduction of 7%, corrected for the different population of patients (with a power of 80% and an alpha of 5%) we need the following numbers:
  • 30 hospitals
  • 750 patients
  • 2 x 25 patients per hospital

Time schedule
July 2016: start using patient decision aid
November 2016: start inclusion
After inclusion of 25 patients hospitals can choose if they want to continue the patient decision aid or not.

Projectleaders
Dr. H.C.J. Scheepers, gynaecologist. MUMC +
Drs. D.M. Koppes, AIOS gynaecology

Methodology
Dr. S.M.J van Kuijk, clinical epidemiologist, MUMC+

Subsidy
ZonMW

Contact (researcher)
Drs D.M. Koppes, AIOS gynaecology, MUMC +
dorien.koppes@mumc.nl