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

Nikita Kumari; Neeru Jain; Rinku Sen Gupta Dhar

doi:10.1007/s13224-021-01446-5

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

J Obstet Gynaecol India. 2021 Jun;71(3):246-253. doi: 10.1007/s13224-021-01446-5. Epub 2021 Feb 11.

Authors

Nikita Kumari¹, Neeru Jain¹, Rinku Sen Gupta Dhar¹

Affiliation

¹ Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016 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.

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