Samenvatting

Objective
To determine the effectiveness of a client or care‐provider strategy to improve the implementation of external cephalic version.

Design
Cluster randomized controlled trial.

Setting
Twenty‐five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands.

Population
Singleton breech presentation from 32 weeks of gestation onwards.

Methods
We randomized clusters to a client strategy (written information leaflets and decision aid), a care‐provider strategy (1‐day counseling course focused on knowledge and counseling skills), a combined client and care‐provider strategy and care‐as‐usual strategy. We performed an intention‐to‐treat analysis.

Main outcome measures
Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt.

Results
The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8–95%. Neither the client strategy (OR 0.8, 95% CI 0.4–1.5) nor the care‐provider strategy (OR 1.2, 95% CI 0.6–2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3–1.4 and OR 2.0, 95% CI 0.7–4.5).

Conclusions
Neither a client nor a care‐provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure.