{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:00:45Z","timestamp":1789477245076,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the effect of a quality improvement project with an educational\/motivational intervention in northern Italy on the implementation of the trial of labor after cesarean section (CS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A pre\u2010post study design was used. Every birth center (<jats:italic>n<\/jats:italic>\u00a0=\u200923) of the Emilia\u2010Romagna region was included. Gynecologist opinion leaders were first trained about Italian CS recommendations. Barriers to implementation were discussed and shared. Educational\/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected during two periods, before (2012\u20132014) and after (2017\u20132019) the intervention (2015\u20132016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 20\u2009496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001). The likelihood of VBAC\u2014adjusted for age 40\u2009years or older, Caucasian, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at least 30, previous vaginal delivery, and labor induction\u2014was increased by the intervention by 42% (odds ratio 1.42, 95% confidence interval 1.31\u20131.54). Neonatal well\u2010being was improved by intervention; neonates requiring resuscitation decreased from 2.1% to 1.6% (<jats:italic>P<\/jats:italic>\u00a0=\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well\u2010being.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14212","type":"journal-article","created":{"date-parts":[[2022,4,9]],"date-time":"2022-04-09T08:21:33Z","timestamp":1649492493000},"page":"810-816","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implementation of guidelines about women with previous cesarean section through educational\/motivational interventions"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1831-3086","authenticated-orcid":false,"given":"Francesca","family":"Monari","sequence":"first","affiliation":[{"name":"Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult University of Modena and Reggio Emilia. University Hospital Policlinico of Modena, Italy  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Menichini","sequence":"additional","affiliation":[{"name":"International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Bertucci","sequence":"additional","affiliation":[{"name":"Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult University of Modena and Reggio Emilia. University Hospital Policlinico of Modena, Italy  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Neri","sequence":"additional","affiliation":[{"name":"Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult University of Modena and Reggio Emilia. University Hospital Policlinico of Modena, Italy  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences (DIBINEM), Hygiene and Preventive Medicine Section, Alma Mater Studiorum University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Facchinetti","sequence":"additional","affiliation":[{"name":"Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult University of Modena and Reggio Emilia. University Hospital Policlinico of Modena, Italy  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,4,22]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"WHO statement on cesarean section rates. 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