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Type: Journal article
Title: SIMPLE: Implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study
Author: Melman, S.
Schoorel, E.
Dirksen, C.
Kwee, A.
Smits, L.
de Boer, F.
Jonkers, M.
Woiski, M.
Mol, B.
Doornbos, J.
Visser, H.
Huisjes, A.
Porath, M.
Delemarre, F.
Kuppens, S.
Aardenburg, R.
Van Dooren, I.
Vrouenraets, F.
Lim, F.
Kleiverda, G.
et al.
Citation: Implementation Science, 2013; 8(3):1-8
Publisher: BioMed Central Ltd
Issue Date: 2013
ISSN: 1748-5908
Statement of
Sonja Melman ... Ben Willem J Mol ... et al.
Abstract: BACKGROUND Caesarean section, CS, rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between, and, weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives, to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines, to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS, to explore barriers and facilitators that have a direct effect on guideline application regarding CS, and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome, based on the information gathered in the second and third objectives, . METHODS An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in, hospitals with a population of, women who delivered by CS, and a random selection of, women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in, hospitals, six intervention, six control hospitals, with regard to effectiveness, experiences, and costs. DISCUSSION This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child. TRIAL REGISTRATION http,, NCT
Keywords: Humans
Pregnancy Complications
Clinical Protocols
Prenatal Care
Cesarean Section
Decision Making
Evidence-Based Medicine
Unnecessary Procedures
Costs and Cost Analysis
Guideline Adherence
Quality Indicators, Health Care
Practice Guidelines as Topic
Practice Patterns, Physicians'
Outcome Assessment, Health Care
Rights: © 2013 Melman et al.; licensee BioMed Central Ltd. 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 work is properly cited.
DOI: 10.1186/1748-5908-8-3
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