From Guideline to Practice: Variation in Late-Term Pregnancy Management Across the Netherlands
Charlotte E A de Deugd1, Corine J M Verhoeven1,2,3,4,5,6, Jeroen van Dillen7
1Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands.
Birth (Berkeley, Calif.)
|June 11, 2026
Summary
Dutch regional protocols show significant variation in implementing the national guideline for late-term pregnancy management. Key recommendations, including shared decision-making, are inconsistently applied, impacting care quality.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Policy and Management
Background:
- The 2021 Dutch national guideline for late-term pregnancy management was established to standardize care and improve outcomes.
- This study assesses regional protocol adherence to this national guideline and identifies variations in late-term pregnancy management.
Purpose of the Study:
- To evaluate regional protocol alignment with the Dutch national guideline for late-term pregnancy management.
- To identify variations in the content and implementation of regional protocols.
Main Methods:
- A cross-sectional study involving content analysis of 60 Dutch regional late-term pregnancy protocols.
- Assessment focused on protocol characteristics, guideline integration, shared decision-making tools, and regional policy choices.
Main Results:
- Significant variation exists in the integration of guideline recommendations across regional protocols.
- Induction at 41 weeks was included in 72% of protocols, but shared decision-making was adopted by only 45%.
- Recommendations for fetal monitoring and nulliparous women's risk were infrequently implemented (43%, 37%, 30%).
Conclusions:
- Substantial variation in protocol content and guideline integration highlights inconsistencies in late-term pregnancy care.
- Lack of clarity in regional protocols and shared decision-making implementation persists.
- Centralizing protocol development may reduce practice variation and enhance care quality.
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