Using healthcare failure mode and effect analysis as a method of vaginal birth after caesarean section management.
Ying Liu, Wei Zhu, Shiguan Le and 3 others
PMID 31532033WHAT IT FOUND
In 144 women choosing trial of labour after caesarean, 130 had vaginal birth during a HFMEA quality improvement programme, and VBAC rate rose from 3.0% to 7.1% over 1 year.
Uterine dehiscence occurred once in 2016, with no severe maternal or neonatal complications.
Key findings
01During the 1-year follow-up, 144 of 2,306 pregnant women with previous caesarean chose trial of labour, and 130 succeeded, a 90.3% success rate.
02The VBAC rate increased steadily by each quarter from 3.0% to 7.1%.
03Uterine dehiscence occurred once in 2016, with no severe maternal or neonatal complications.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The project was done in one tertiary maternal and child hospital in Shanghai, so results may not apply elsewhere. It compared previous data and could not be randomised, so other changes over the same period may explain the rise. Only women with one previous caesarean were allowed for trial of labour, so the paper does not address women with more than one caesarean. The authors note limited numbers of subjects in 2013 and say further high-quality clinical trials are still needed. Fourteen failure modes were addressed with many actions at once, so the contribution of any single action cannot be separated.
The easy way to misread this
Do not conclude that the HFMEA programme caused the rise in VBAC rates. The project compared previous data, was not randomised, and many actions were introduced together, so the effect of any single component cannot be separated.