School of Medicine and Health Sciences Poster Presentations

Title

Cesarean Delivery Prevention: The Vaginal Breech Initiative

Poster Number

341

Document Type

Poster

Status

Medical Student

Abstract Category

Women/Child Health

Keywords

vaginal breech, cesarean prevention, breech initiative

Publication Date

Spring 2018

Abstract

INTRODUCTION: Reducing the cesarean delivery rate is a national priority. Performing vaginal breech deliveries can be one important component of a cesarean reduction strategy. Scientific evidence, professional recommendations and consumer demand have all shifted to support vaginal breech delivery as an option to routine cesarean delivery for breech presentations. At the George Washington University Hospital (GWUH), we have established a Vaginal Breech Initiative to increase access to vaginal breech delivery. We are currently studying deferred, attempted and successful vaginal breech deliveries performed at GWUH after the institution of the Vaginal Breech Initiative. We hope to identify the components of successful and unsuccessful vaginal breech deliveries, as well as look at the outcomes of these deliveries. This interim analysis aims to describe our vaginal breech success rate and identify which breech vaginal deliveries were conducted as a part of the Initiative and adhered to our protocol.

METHODS: This is an observational report and interim data analysis of the vaginal breech labors and deliveries managed by a Breech Vaginal Team at GWUH. Electronic medical record (EMR) query identified all charts with relevant ICD-9 codes. A retrospective chart review of planned, attempted, and deferred vaginal breech deliveries at GWU Hospital from 2014-2017 was conducted.

RESULTS: This is an interim analysis based on review of 398 patient charts. Preliminary outcome data from patients attempting a breech vaginal delivery (n=50) at GWUH demonstrate a 76% vaginal breech success rate. Of the total attempted vaginal breech deliveries, 70% (n=35) occurred in the context of the Vaginal Breech Initiative. Of these, provider adherence to the established protocol was demonstrated in 91.4% (n=32) of cases.

CONCLUSION: Improving access to, and training in vaginal breech at GWUH has contributed to a reduced cesarean delivery rate and increased patient satisfaction. It has also provided critical training and skills for our health care providers. Through careful diagnosis, patient selection, counseling, and collaboration, breech vaginal deliveries performed in the context of a Vaginal Breech Initiative are feasible in an academic medical center. This ongoing project requires continued review of patient charts to further evaluate our vaginal breech processes.

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Cesarean Delivery Prevention: The Vaginal Breech Initiative

INTRODUCTION: Reducing the cesarean delivery rate is a national priority. Performing vaginal breech deliveries can be one important component of a cesarean reduction strategy. Scientific evidence, professional recommendations and consumer demand have all shifted to support vaginal breech delivery as an option to routine cesarean delivery for breech presentations. At the George Washington University Hospital (GWUH), we have established a Vaginal Breech Initiative to increase access to vaginal breech delivery. We are currently studying deferred, attempted and successful vaginal breech deliveries performed at GWUH after the institution of the Vaginal Breech Initiative. We hope to identify the components of successful and unsuccessful vaginal breech deliveries, as well as look at the outcomes of these deliveries. This interim analysis aims to describe our vaginal breech success rate and identify which breech vaginal deliveries were conducted as a part of the Initiative and adhered to our protocol.

METHODS: This is an observational report and interim data analysis of the vaginal breech labors and deliveries managed by a Breech Vaginal Team at GWUH. Electronic medical record (EMR) query identified all charts with relevant ICD-9 codes. A retrospective chart review of planned, attempted, and deferred vaginal breech deliveries at GWU Hospital from 2014-2017 was conducted.

RESULTS: This is an interim analysis based on review of 398 patient charts. Preliminary outcome data from patients attempting a breech vaginal delivery (n=50) at GWUH demonstrate a 76% vaginal breech success rate. Of the total attempted vaginal breech deliveries, 70% (n=35) occurred in the context of the Vaginal Breech Initiative. Of these, provider adherence to the established protocol was demonstrated in 91.4% (n=32) of cases.

CONCLUSION: Improving access to, and training in vaginal breech at GWUH has contributed to a reduced cesarean delivery rate and increased patient satisfaction. It has also provided critical training and skills for our health care providers. Through careful diagnosis, patient selection, counseling, and collaboration, breech vaginal deliveries performed in the context of a Vaginal Breech Initiative are feasible in an academic medical center. This ongoing project requires continued review of patient charts to further evaluate our vaginal breech processes.