Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study

Emy Vankan; Ellen N. C. Schoorel; Sander M. J. van Kuijk; Ben-Willem J. Mol; Jan G. Nijhuis; Robert Aardenburg; Marleen Alink; Karin de Boer; Friso M. C. Delemarre; Carmen D. Dirksen; Ivo M. A. Van Dooren; Maureen T. M. Franssen; Mesrure Kaplan; Gunilla Kleiverda; Simone M. I. Kuppens; Anneke Kwee; Josje Langenveld; Frans T. H. Lim; Sonja Melman; Marko J. Sikkema; Luc J. Smits; Harry Visser; Mallory Woiski; Hubertina C. Scheepers; Rosella P. M. G. Hermens

doi:10.1111/aogs.13059

Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study

Emy Vankan^*, Ellen N. C. Schoorel, Sander M. J. van Kuijk, Ben-Willem J. Mol, Jan G. Nijhuis, Robert Aardenburg, Marleen Alink, Karin de Boer, Friso M. C. Delemarre, Carmen D. Dirksen, Ivo M. A. Van Dooren, Maureen T. M. Franssen, Mesrure Kaplan, Gunilla Kleiverda, Simone M. I. Kuppens, Anneke Kwee, Josje Langenveld, Frans T. H. Lim, Sonja Melman, Marko J. SikkemaLuc J. Smits, Harry Visser, Mallory Woiski, Hubertina C. Scheepers, Rosella P. M. G. Hermens

^*Corresponding author for this work

Reproductive Origins of Adult Health and Disease (ROAHD)

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

Abstract

IntroductionLarge practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level.

Material and methodsThis retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R-2 measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the correlation between standardized elective repeat cesarean section and vaginal birth after cesarean rates.

ResultsIn all, 1068 women had a history of cesarean section, of whom 71% were eligible for inclusion. A total of 515 women (67%) had a trial of labor, of whom 72% delivered vaginally. The elective repeat cesarean section rate at hospital level ranged from 6 to 54% (mean 29.8, standard deviation 11.8%). Vaginal birth after cesarean rates ranged from 50 to 90% (mean 71.8%, standard deviation 11.1%). More than 85% of this practice variation could not be explained by risk factors at patient level.

ConclusionA large practice variation exists in elective repeat cesarean section and vaginal birth after cesarean rates that can only partially be explained by risk factors at patient level.

Original language	English
Pages (from-to)	158-165
Number of pages	8
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	96
Issue number	2
DOIs	https://doi.org/10.1111/aogs.13059
Publication status	Published - Feb-2017

Keywords

Cesarean section
practice variation
risk factors
trial of labor
vaginal birth after cesarean
SECTION
WOMEN

Access to Document

10.1111/aogs.13059

Handle.net

Persistent link

Embargoed Document

Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: a retrospective cohort study
Final publisher's version, 309 KB

Cite this

Vankan, E., Schoorel, E. N. C., van Kuijk, S. M. J., Mol, B.-W. J., Nijhuis, J. G., Aardenburg, R., Alink, M., de Boer, K., Delemarre, F. M. C., Dirksen, C. D., Van Dooren, I. M. A., Franssen, M. T. M., Kaplan, M., Kleiverda, G., Kuppens, S. M. I., Kwee, A., Langenveld, J., Lim, F. T. H., Melman, S., ... Hermens, R. P. M. G. (2017). Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study. Acta Obstetricia et Gynecologica Scandinavica, 96(2), 158-165. https://doi.org/10.1111/aogs.13059

@article{6c632998fd0543d59a4de48da8294f8d,

title = "Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study",

abstract = "IntroductionLarge practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level.Material and methodsThis retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R-2 measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the correlation between standardized elective repeat cesarean section and vaginal birth after cesarean rates.ResultsIn all, 1068 women had a history of cesarean section, of whom 71% were eligible for inclusion. A total of 515 women (67%) had a trial of labor, of whom 72% delivered vaginally. The elective repeat cesarean section rate at hospital level ranged from 6 to 54% (mean 29.8, standard deviation 11.8%). Vaginal birth after cesarean rates ranged from 50 to 90% (mean 71.8%, standard deviation 11.1%). More than 85% of this practice variation could not be explained by risk factors at patient level.ConclusionA large practice variation exists in elective repeat cesarean section and vaginal birth after cesarean rates that can only partially be explained by risk factors at patient level.",

keywords = "Cesarean section, practice variation, risk factors, trial of labor, vaginal birth after cesarean, SECTION, WOMEN",

author = "Emy Vankan and Schoorel, {Ellen N. C.} and {van Kuijk}, {Sander M. J.} and Mol, {Ben-Willem J.} and Nijhuis, {Jan G.} and Robert Aardenburg and Marleen Alink and {de Boer}, Karin and Delemarre, {Friso M. C.} and Dirksen, {Carmen D.} and {Van Dooren}, {Ivo M. A.} and Franssen, {Maureen T. M.} and Mesrure Kaplan and Gunilla Kleiverda and Kuppens, {Simone M. I.} and Anneke Kwee and Josje Langenveld and Lim, {Frans T. H.} and Sonja Melman and Sikkema, {Marko J.} and Smits, {Luc J.} and Harry Visser and Mallory Woiski and Scheepers, {Hubertina C.} and Hermens, {Rosella P. M. G.}",

year = "2017",

month = feb,

doi = "10.1111/aogs.13059",

language = "English",

volume = "96",

pages = "158--165",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley",

number = "2",

}

Vankan, E, Schoorel, ENC, van Kuijk, SMJ, Mol, B-WJ, Nijhuis, JG, Aardenburg, R, Alink, M, de Boer, K, Delemarre, FMC, Dirksen, CD, Van Dooren, IMA, Franssen, MTM, Kaplan, M, Kleiverda, G, Kuppens, SMI, Kwee, A, Langenveld, J, Lim, FTH, Melman, S, Sikkema, MJ, Smits, LJ, Visser, H, Woiski, M, Scheepers, HC & Hermens, RPMG 2017, 'Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study', Acta Obstetricia et Gynecologica Scandinavica, vol. 96, no. 2, pp. 158-165. https://doi.org/10.1111/aogs.13059

Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study. / Vankan, Emy; Schoorel, Ellen N. C.; van Kuijk, Sander M. J. et al.
In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 96, No. 2, 02.2017, p. 158-165.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level

T2 - A retrospective cohort study

AU - Vankan, Emy

AU - Schoorel, Ellen N. C.

AU - van Kuijk, Sander M. J.

AU - Mol, Ben-Willem J.

AU - Nijhuis, Jan G.

AU - Aardenburg, Robert

AU - Alink, Marleen

AU - de Boer, Karin

AU - Delemarre, Friso M. C.

AU - Dirksen, Carmen D.

AU - Van Dooren, Ivo M. A.

AU - Franssen, Maureen T. M.

AU - Kaplan, Mesrure

AU - Kleiverda, Gunilla

AU - Kuppens, Simone M. I.

AU - Kwee, Anneke

AU - Langenveld, Josje

AU - Lim, Frans T. H.

AU - Melman, Sonja

AU - Sikkema, Marko J.

AU - Smits, Luc J.

AU - Visser, Harry

AU - Woiski, Mallory

AU - Scheepers, Hubertina C.

AU - Hermens, Rosella P. M. G.

PY - 2017/2

Y1 - 2017/2

N2 - IntroductionLarge practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level.Material and methodsThis retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R-2 measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the correlation between standardized elective repeat cesarean section and vaginal birth after cesarean rates.ResultsIn all, 1068 women had a history of cesarean section, of whom 71% were eligible for inclusion. A total of 515 women (67%) had a trial of labor, of whom 72% delivered vaginally. The elective repeat cesarean section rate at hospital level ranged from 6 to 54% (mean 29.8, standard deviation 11.8%). Vaginal birth after cesarean rates ranged from 50 to 90% (mean 71.8%, standard deviation 11.1%). More than 85% of this practice variation could not be explained by risk factors at patient level.ConclusionA large practice variation exists in elective repeat cesarean section and vaginal birth after cesarean rates that can only partially be explained by risk factors at patient level.

AB - IntroductionLarge practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level.Material and methodsThis retrospective cohort study was performed among 17 Dutch hospitals in 2010. Women with one prior cesarean section without a contraindication for a trial of labor were included. We used multivariate logistic regression analysis to develop models for risk factor adjustments. One model was derived to adjust the elective repeat cesarean section rates; a second model to adjust vaginal birth after cesarean rates. Standardized rates of elective repeat cesarean section and vaginal birth after cesarean per hospital were compared. Pseudo-R-2 measures were calculated to estimate the percentage of practice variation explained by the models. Secondary outcomes were differences in practice variation between hospital types and the correlation between standardized elective repeat cesarean section and vaginal birth after cesarean rates.ResultsIn all, 1068 women had a history of cesarean section, of whom 71% were eligible for inclusion. A total of 515 women (67%) had a trial of labor, of whom 72% delivered vaginally. The elective repeat cesarean section rate at hospital level ranged from 6 to 54% (mean 29.8, standard deviation 11.8%). Vaginal birth after cesarean rates ranged from 50 to 90% (mean 71.8%, standard deviation 11.1%). More than 85% of this practice variation could not be explained by risk factors at patient level.ConclusionA large practice variation exists in elective repeat cesarean section and vaginal birth after cesarean rates that can only partially be explained by risk factors at patient level.

KW - Cesarean section

KW - practice variation

KW - risk factors

KW - trial of labor

KW - vaginal birth after cesarean

KW - SECTION

KW - WOMEN

U2 - 10.1111/aogs.13059

DO - 10.1111/aogs.13059

M3 - Article

SN - 0001-6349

VL - 96

SP - 158

EP - 165

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 2

ER -

Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: A retrospective cohort study

Abstract

Keywords

Access to Document

Handle.net

Embargoed Document

Fingerprint

Cite this