Effect of a Locally Tailored Clinical Pathway Tool on VBAC Outcomes in a Private Hospital in India

Abstract

Background

Customized clinical and administrative interventions in the form of a care pathway tool can improve VBAC outcomes and reduce the alarming rise in caesarean sections globally.

Objective

To determine the effect of a locally tailored clinical pathway tool on VBAC outcomes in a private hospital in India.

Methods

A pre- and post-implementation study was conducted in a private hospital in India. All women with one previous caesarean section term pregnancy and cephalic presentation were included at baseline from January 2013 to December 2015 (Phase 1) and from January 2016 to December 2018 (Phase 2) after ongoing implementation of a clinical pathway tool by all providers. Background characteristics and clinical outcomes in both phases were reviewed retrospectively from case files.

Results

Overall 223 (13.42%) women among 1661 total births and 244 (11.62%) women among 2099 total births were included in Phase 1 and Phase 2, respectively. Total number of women who underwent trial of labour (TOLAC) increased from 36.77% to 64.34% (P < 0.001) and VBAC rate increased from 23.76% to 58.19% (P < 0.001) in Phase 2. There was no significant difference in perinatal morbidity and mortality in the two phases.

Conclusion

A locally customized clinical care pathway tool implemented to support both mothers and care givers for TOLAC seemed to improve VBAC outcomes in a private setting in India.

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Fig. 1

References

  1. 1.

    Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top Guideline No. 45. London, UK: RCOG; 2015

  2. 2.

    SOGC clinical practice guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155 (Replaces guideline Number 147), February 2005

  3. 3.

    Ryan GA, Nicholson SM, Morrison JJ. Vaginal birth after caesarean section: Current status and where to from here?.Eur J Obstet Gynecol Reprod Biol. 2018;224:52‐57

  4. 4.

    Jain R. Safety of vaginal birth after single previous lower segment caesarean: a retrospective analysis of 200 cases. Int J Reprod Contracept Obstet Gynecol. 2018;7(7):2596–602.

    Article  Google Scholar 

  5. 5.

    Dhillon BS, Chandhiok N, Bharti S, Bhatia P, Coyaji KJ, Das MC. Vaginal birth after cesarean section (VBAC) versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study. Int J Reprod Contracept Obstet Gynecol. 2014;3:592–7.

    Article  Google Scholar 

  6. 6.

    Chauhan SP, Martine JN, Henrichs CE, Morrison JC, Magann EF. Maternal and perinatal complication with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: a review of the literature. Am J Obstet Gynecol. 2003;189:408–17.

    Article  Google Scholar 

  7. 7.

    Royal College of Obstetricians and Gynaecologists. Umbilical Cord Prolapse: Green-top Guideline No. 50. London, UK: RCOG; 2014.

  8. 8.

    Igwegbe AO, Eleje GU, Okpala BC. Management outcomes of abruptio placentae at Nnamdi Azikiwe University teaching hospital, Nnewi. Nigeria Niger J Med. 2013;22(3):234–8.

    CAS  PubMed  Google Scholar 

  9. 9.

    Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. 2009;360(2):111–20.

    CAS  Article  Google Scholar 

  10. 10.

    Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226–32.

    Article  Google Scholar 

  11. 11.

    Clarke M, Savage G, Smith V, et al. Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH trial): study protocol for a randomised controlled trial (ISRCTN10612254). Trials. 2015;16:542.

    Article  Google Scholar 

  12. 12.

    Tabish SA. The clinical pathways approach to patient care. JK Practitioner J Curr Clinic Medic Surg. 2001;8(1):59–62.

    Google Scholar 

  13. 13.

    Cannon CP. Critical pathways for acute myocardial infarction. Rev Cardiovasc Med. 2003;4(Suppl 3):S47–53.

    PubMed  Google Scholar 

  14. 14.

    Clarke LK. Pathways for head and neck surgery: a patient-education tool. Clin J of Onc Nur. 2002;6:78–82.

    Article  Google Scholar 

  15. 15.

    Nagpal J, Sachdeva A, Sengupta Dhar R, Bhargava VL, Bhartia A. Widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey. BJOG. 2015;122(2):238–47.

    CAS  Article  Google Scholar 

  16. 16.

    Gardner K, Henry A, Thou S, Davis G, Miller T. Improving VBAC rates: the combined impact of two management strategies. Aust N Z J Obstet Gynaecol. 2014;54(4):327–32.

    Article  Google Scholar 

  17. 17.

    Shorten A, Shorten B, Keogh J, West S, Morris J. Making choices for childbirth: a randomized controlled trial of a decision-aid for informed birth after cesarean. Birth. 2005;32(4):252–61.

    Article  Google Scholar 

  18. 18.

    Bangal VB, Giri PA, Shinde KK, Gavhane SP. Vaginal birth after cesarean section. N Am J Med Sci. 2013;5(2):140.

    Article  Google Scholar 

  19. 19.

    Eskandar M, Aboud J, Alshahrani M, Hassanein M, Alyamani A. Optimization of clinical outcome of women with previous one lower segment cesarean section. Open J Obstet Gynecol. 2012;2(03):265.

    Article  Google Scholar 

  20. 20.

    Guiliano M, Closset E, Therby D, LeGoueff F, Deruelle P, Subtil D. Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery. Eur J Obstet Gynecol Reprod Biol. 2014;179:130–4.

    CAS  Article  Google Scholar 

  21. 21.

    Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Uterine rupture by intended mode of delivery in the UK: a national case-control study. PLoS Med. 2012;9(3):e1001184.

    Article  Google Scholar 

  22. 22.

    Dekker GA, Chan A, Luke CG, Priest K, Riley M, Halliday J, et al. Risk of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective population-based cohort study. BJOG. 2010;117:1358–65.

    CAS  Article  Google Scholar 

  23. 23.

    Singh A, Shrivastava C. Uterine Rupture: Still a Harsh Reality! J Obstet Gynaecol India. 2015;65(3):158–61.

    Article  Google Scholar 

  24. 24.

    Salman L, Aharony S, Shmueli A, Wiznitzer A, Chen R, Gabbay-Benziv R. Urinary bladder injury during cesarean delivery: Maternal outcome from a contemporary large case series. Eur J Obstet Gynecol Reprod Biol. 2017;213:26–30.

    Article  Google Scholar 

  25. 25.

    Royal College of Obstetricians and Gynaecologists. Postpartum Haemorrhage, Prevention and Management (Green-top Guideline No. 52). London: RCOG; 2016.

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Acknowledgments

We are grateful to Mr. Abhishek Bhartia, CEO of the hospital, for continuous encouragement and administrative support. In particular, we would like to thank the senior providers Dr Swati Sinha, Dr Anita Sabherwal, Dr Priti Arora and Dr Payal Chaudhary for their clinical contribution. Furthermore, we would like to thank Pradya, quality officer, for data collection.

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Correspondence to Nikita Kumari.

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Nikita Kumari, Neeru Jain and Rinku Sen Gupta Dhar declare that they have no conflict of interest.

Research Involving Human Participants and Informed Consent

Our study involved anonymous review of relevant clinical parameters from case records, before and after implementation of a clinical care pathway tool which was a bundle of evidence-based practices. No consent was taken as data were collected from case records retrospectively. Ethical approval was taken from institutional ethics committee.

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Nikita Kumari is a DNB Obstetrics & Gynaecology, Attending Consultant, Department of Obstetrics & Gynaecology at Sitaram Bhartia Institute of Science & Research, B-16 Qutab Institutional Area, New Delhi, 110016, India ; Neeru Jain is DGO Obstetrics & Gynaecology, Attending Consultant, Department of Obstetrics & Gynaecology at Sitaram Bhartia Institute of Science & Research, B-16 Qutab Institutional Area, New Delhi, 110016, India; Rinku Sen Gupta Dhar is MD Obstetrics & Gynaecology, Senior Consultant, Department of Obstetrics & Gynaecology at Sitaram Bhartia Institute of Science & Research, B-16 Qutab Institutional Area, New Delhi, 110016, India

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Kumari, N., Jain, N. & Dhar, R.S.G. Effect of a Locally Tailored Clinical Pathway Tool on VBAC Outcomes in a Private Hospital in India. J Obstet Gynecol India (2021). https://doi.org/10.1007/s13224-021-01446-5

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Keywords

  • Vaginal birth after caesarean section (VBAC)
  • Trial of labour after caesarean (TOLAC)
  • Elective repeat caesarean section (ERCS)
  • VBAC attempt rate
  • VBAC rate
  • VBAC success rate
  • Clinical care pathway
  • Robson V