An e-Delphi study on mode of delivery and extremely preterm breech singletons

Area of Science:

• Maternal-Fetal Medicine
• Neonatalogy
• Clinical Consensus Studies

Background:

• Mode of delivery for extremely preterm breech infants remains a complex clinical decision.
• Understanding clinician consensus and knowledge of neonatal outcomes is crucial for optimizing care.
• Previous studies highlight variability in decision-making for these high-risk deliveries.

Purpose of the Study:

• To determine expert clinician consensus on the mode of delivery for extremely preterm breech infants.
• To assess clinicians' knowledge of associated neonatal outcomes.
• To evaluate the impact of neonatal outcome data on consensus regarding delivery mode.

Main Methods:

• A two-round Delphi study involving obstetrical and neonatal care providers.
• Participants responded to vignettes assessing decision-making and knowledge in round one.
• Round two involved reassessment of vignettes after providing neonatal outcome data.

Main Results:

• Limited consensus (≥75% agreement) was achieved in only 4 out of 13 vignettes in round one.
• Consensus for Cesarean delivery was more likely at 26-27 weeks gestation.
• Clinicians generally underestimated neonatal outcomes, and providing this data influenced decisions in round two.

Conclusions:

• There is a lack of consensus among clinicians regarding the mode of delivery for extremely preterm breech infants.
• Underestimation of neonatal outcomes contributes to this limited consensus.
• Informing clinicians about neonatal outcomes can potentially improve agreement on delivery strategies.