Title: Results of the German part of OptiBIRTH (ISRCTN10612254) : a cluster randomised trial to increase vaginal birth after one previous caesarean section
Authors : Gross, Mechthild Maria
Grylka, Susanne
Bahlmann, F
Fleisch, M
Hillemanns, P
Kaisenberg, C
Koch, F
Schild, RL
Clarke, M
Begley, C
Published in : Zeitschrift für Geburtshilfe und Neonatologie
Conference details: 28. Deutscher Kongress für perinatale Medizin, Berlin, 30.11–02.12.2017
Publisher / Ed. Institution : Thieme
Issue Date: 2017
License (according to publishing contract) : Licence according to publishing contract
Type of review: Not specified
Language : English
Subject (DDC) : 618.4: Childbirth
Abstract: Objective: The OptiBIRTH intervention was developed to enhance women-centred care for pregnant women who had had one previous caesarean section. Firstly, systematic reviews and focus group interviews with clinicians and women were carried out. Another systematic review focused on computer-based behavioural change interventions informed the design of an online component of the OptiBIRTH intervention, which was then tested in the trial to assess its impact on the VBAC rate in the German sites, as well as on interventions and events during labour. Methods: A cluster randomised trial (ISRCTN10612254) was carried out in 15 sites in three European countries (Ireland, Italy, Germany). The German part of the study was led by the Midwifery Research and Education Unit at Hannover Medical School (MiREdU). The participating sites were Buergerhospital Frankfurt, Diakovere Krankenhaus Henriettenstift Hannover, Klinikum Dritter Orden Muenchen, University hospital Wuppertal, and Hannover Medical School. The sites were randomly allocated into three intervention and two control sites. Recruitment of women took place between May 2014 and October 2015. Main international analysis was performed by Queen's University Belfast. Intranational comparisons in Germany were performed by MiREdU using descriptive statistics. Data of the baseline rate came from 2012 compared with data from 2015, which is an interim analysis pending the final comparison to 2016. Results: Overall, there was no statistically significant difference in the change in the proportion of women having a VBAC between 2012 and 2015 in the intervention sites compared to the controls. Although there were significant changes in Italy and Ireland, there were none in Germany. The 2015 VBAC rates in the German sites showed an increase compared to baseline (2012) in one intervention site (+1.0%) and in one control site (+3.2%) but decreases in the three other sites (-0.1, -6.2 and -10.1%). Regarding German OptiBIRTH participants, there was no significant difference in VBAC rates between intervention and control sites (39.1 vs. 40.3%, p = 0.75). There was no significant difference in the frequencies of labour induction (23.2 vs. 20.5%, p = 0.51), amniotomy (16.1 vs. 22.0%, p = 0.13), or oxytocin (47.5 vs. 47.0%, p = 0.93) between intervention and control sites. Epidural analgesia was significantly higher in control compared to intervention sites (45.8 vs. 28.5%, p < 0.001). Opioid application was significantly more common in intervention than in control sites (31.1 vs. 7.7%, p < 0.001). The median duration between onset of labour and birth was significantly shorter in intervention compared to control sites (7.63 vs. 9.95 hrs, p = 0.04). Conclusions: The OptiBIRTH intervention was safe but not effective at increasing VBAC rates in the whole study population or in the German part of the study. It might be more successful in countries with very low rates. Interinstitutional variations in obstetric practice are obvious in Germany.
Departement: Gesundheit
Organisational Unit: Institute of Midwifery (IHB)
Publication type: Conference Other
DOI : 10.1055/s-007-35181
URI: https://digitalcollection.zhaw.ch/handle/11475/8032
Appears in Collections:Publikationen Gesundheit

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