Impact of Audits and Multifaceted Intervention on Vaginal Birth After Caesarean: Secondary Analysis of QUARISMA Trial.

OBJECTIVES: This study estimated the effect that a multifaceted intervention aiming to improve the quality of obstetrical care and reduce CS had on the rate of VBAC.

METHODS: This is a secondary analysis of the cluster RCT Quality of Care, Obstetrics Risk Management, and Mode of Delivery involving (1) audits regarding the indications for CS, (2) provision of feedback to health professionals, and (3) implementation of best practices to reduce CS rates in Quebec. The impact of intervention on VBAC, trial of labour (TOL), and maternal and neonatal morbidity was reported using adjusted ORs with 95% CIs.

RESULTS: Out of 105 351 women who delivered during the pre- and postintervention period, 12 493 (11.9%) had a previous CS. We observed no significant impact of the multifaceted intervention on the rates of TOL (adjusted OR 1.22; 95% CI 0.96-1.56, P = 0.11) and VBAC (adjusted OR 1.20; 95% CI 0.97-1.48, P = 0.10) in women with one previous CS. However, the rate of TOL was reduced (adjusted OR 0.38; 95% CI 0.14-0.99) in women with more than one previous CS. The intervention has no influence on maternal and neonatal morbidity.

CONCLUSIONS: A multifaceted intervention including audits, feedback to health professionals, and implementation of best practices did not affect VBAC rates or maternal and neonatal morbidity. Our results pointed out the need for decision-making process and risk management tools specific to women with previous CS.