TY - JOUR
T1 - The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section
T2 - A prospective cohort study
AU - Vankan, Emy
AU - Schoorel, Ellen
AU - van Kuijk, Sander
AU - Nijhuis, Jan
AU - Hermens, Rosella
AU - Scheepers, Hubertina
AU - SIMPLE study group
N1 - Funding Information:
This study was funded by The Netherlands Organization for Health Research and Development (ZonMw) (Grant No 17100.3006). https://www.zonmw.nl/nl/. HS received this award. After The Netherlands Organization for Health Research and Development approved the study protocol and design, they were not involved in collection, analysis, and interpretation of data and writing and submitting the article. Members of the SIMPLE study group Ben-Willem Mol, Department of Obstetrics and Gynaecology, The Robinson Research Institute of Paediatrics and Reproductive Health, University of Adelaide and The South Australian Health and Medical Research Institute, Adelaide, Australia Robert Aardenburg, Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Sittard, The Netherlands Friso Delemarre, Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands Carmen Dirksen, Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands Ivo van Dooren, Department of Obstetrics and Gynaecology, Sint Jans Gasthuis, Weert, The Netherlands Simone MI Kuppens, Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands Anneke Kwee, Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands Josje Langenveld, Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands Luc J Smits, Caphri School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands The authors would like to thank the following persons for their substantive contribution to this study: Dorien Hunen, MD, dorienhunen@gmail.com ? data collection, research student at Maastricht University, no funding, no conflicts of interest. Anouk van den Bosch, MD, a.vdbosch@hotmail.com ? data collection, research student at Maastricht University, no funding, no conflicts of interest.
Publisher Copyright:
© 2019 Vankan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/9/26
Y1 - 2019/9/26
N2 - OBJECTIVE: After 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.METHODS: We 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.RESULTS: There 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).CONCLUSIONS: Implementing 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.
AB - OBJECTIVE: After 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.METHODS: We 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.RESULTS: There 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).CONCLUSIONS: Implementing 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.
KW - Adult
KW - Cesarean Section
KW - Cesarean Section, Repeat
KW - Decision Support Techniques
KW - Female
KW - Humans
KW - Pregnancy
KW - Prospective Studies
KW - Risk Assessment/methods
KW - Vaginal Birth after Cesarean/adverse effects
KW - SUCCESSFUL VAGINAL BIRTH
KW - MANAGEMENT
KW - SUCCESS
KW - PREDICTION MODEL
KW - TRIAL
KW - WOMEN
KW - LABOR
U2 - 10.1371/journal.pone.0222499
DO - 10.1371/journal.pone.0222499
M3 - Article
C2 - 31557177
SN - 1932-6203
VL - 14
JO - PLOS ONE
JF - PLOS ONE
IS - 9
M1 - 0222499
ER -