Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling.The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured.This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term.Dutch Trial Register (NTR): 1878Breech presentation occurs in 3 to 4% of all term pregnancies [1]. In pregnancies complicated by breech presentation, perinatal mortality, neonatal mortality or serious neonatal morbidity are increased as compared to pregnancies where the fetes is in cephalic position [2]. Breech position at term occurs in 8.000 pregnancies in the Netherlands each year. Until 2000 the mode of breech delivery was controversial. Since publication of th