From Guideline to Practice: Variation in Late-Term Pregnancy Management Across the Netherlands

Introduced in 2021, the Dutch national guideline on late-term pregnancy management aims to standardize care, reduce regional variation, and optimize maternal and perinatal outcomes. This study aimed to evaluate the extent to which regional protocols adhere to this Dutch national guideline and assess variation in the content of protocols for late-term pregnancy management.

In this cross-sectional study, content analysis of 60 Dutch regional late-term pregnancy protocols was performed to assess alignment with the Dutch national guideline. Key variables included protocol characteristics, integration of guideline recommendations, use of shared decision-making tools, and regional policy choices.

The integration of guideline recommendations varied largely among regional protocols. Induction of labor at 41 weeks alongside the option of expectant management was incorporated into 72% of the protocols, while the recommendation to facilitate shared decision-making was adopted in only 45%. The two recommendations regarding fetal monitoring and the recommendation on increased risk for nulliparous women were infrequently implemented (43%, 37%, and 30%). The implementation of late-term choices varied considerably in terms of shared decision-making conversation timing, additional monitoring, and available alternatives.

Substantial variation was found in protocol content and the integration of guideline recommendations. Although the guideline highlights the importance of shared decision-making, a lack of clarity remains regarding the content, purpose, and scope of regional protocols. Restructuring the current system of protocol development from regional working groups to a centralized organization may help reduce practice variation and improve the quality of care.