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ECV implementation

Go to the Implementation of ECV website

Breech presentation occurs in 3 4 % of al term pregnancies. External cephalic version (ECV)  is an intervention to prevent breech position at delivery and is therefore advised in guidelines for gynaecologists and midwifes. The implementation of external cephalic version is at maximum 70%, but probably less, and success rates of ECV are only 40%. The aim of the present study is to identify both impeding as well as facilitating factors and to develop and evaluate an implementation strategy based on proper counselling of pregnant women and their care providers.

Study design
During the first phase of the project we will identify both facilitating as well as impeding factors. Subsequently we will identify an implementation strategy focused on counselling of pregnant women with a child in breech position and counselling of their health care providers.
In the third phase of the project we will evaluate in a randomized clinical trial the effectiveness of the developed strategy. The study will be performed in 32 of the 100 Dutch hospitals.

External cephalic version in breech position


Outcome measures
Primary: the number of patients that undergo an external cephalic version procedure.

Secondary: we will look at the number of babies in cephalic position at delivery.

Complications as a consequence of external cephalic version and the number of Caesarean sections as well as perinatal condition of mother and child. We will also assess the cost effectiveness of implementation strategies.

Time schedule
Assessment of barriers and facilitators: 12 months

- Development of the strategies: 6 months

- Randomised clinical trial: 12 months

- Evaluation and report: 6 months


Phase 1 Determinant analyses

Assessment quality indicators (month 1-4)

Focusgroup interview and individual interviews (month 1-6)

Questionnaires (month 4-12)


Phase 2 Implementation activities

Development implementation strategy  (month 8-12)


Phase 3 Evaluation

Pilot testing implementation strategy (month 13-14)

Carrying out implementation strategy 32 hospitals  (month 15-20)

Effect evaluation (month 18-32)

Process evaluation (month 28-32)

Cost analysis (month 20-36)

Analyses and report (month 28-36)


Determinant analysis

Focusgroup interview and individual interviews (month 1-6)

Questionnaires (month 4-10)


Implementation activities:

Development implementation strategy  (month 10-15)


Research activities:

Quality indicators  (month 4-10)

Feasibility study implementation strategy  (moth 10-14)

Preparation + implementation strategy (month 16-20)

Effect evaluation (month 20-31)

Process evaluation (month 20-31)

Cost analysis  (month 20-36)

Analyses and report (month 31-36)

Prof. dr. B.W.J. Mol, gynaecologist, AMC Amsterdam

Dr. M. Kok, AMC Amsterdam