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

Journal of Perinatology volume 43, pages 15–22 (2023)Cite this article

Subjects

Abstract

Objectives

To understand clinicians’ consensus on mode of delivery in extremely preterm breech infants; assess knowledge on neonatal outcomes and its impact on consensus.

Study design

A two-round Delphi of obstetrical or neonatal care providers, recruited from national conferences and investigator networks. Round one assessed decision-making (vignettes), and knowledge; the second round reassessed vignettes after presenting outcome data.

Results

In round one (102 respondents), consensus (a priori, ≥75% agreement) was achieved in 4/13 vignettes: two when likely/very likely to offer Cesarean (26 and 27 weeks) and two for unlikely/very unlikely (23 weeks growth restriction, ± adverse features). Clinicians generally underestimated neonatal outcomes. In round two (87 respondents), three scenarios achieved consensus (likely/very likely to offer Cesarean at 25–27 weeks); in five other vignettes, not offering Cesarean was reduced in ≥15% of respondents.

Conclusion

Limited consensus exists on extremely preterm breech mode of delivery, partly associated with neonatal outcome underestimation.

Gestational age notation

The authors follow the World Health Organization’s notation on gestational age. Under this notation, the first day of the last menstrual period (LMP) is day 0 of week 0. Therefore, days 0–6 represent completed week 0, days 7–13 represent completed week 1 and so on.

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Fig. 1: Graphical abstract.
Fig. 2: Consensus or dissensus in offering cesarean section in various clinical vignettes.
Fig. 3: Discordance between actual neonatal outcomes and clinician estimated outcomes per week of gestational age at birth.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all the participants in this, the parent surveys, and those who assisted with their piloting.We would like to acknowledge Dr. Amit Mukerji (Department of Pediatrics, Division of Neonatology, McMaster University) for his assistance with the interpretation of the data and Ola Elsharif for her design and editing of the graphical abstract.

Funding

This study was supported by the Hamilton Academic Health Sciences Organization Academic Health Science Centre Alternate Funding Plan from the Ministry of Health and Long-term Care Innovation Fund (# HAH-19-04).

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON, Canada

    Alexandra Marseu & Sarah D. McDonald

  2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Pasqualina Santaguida & Sarah D. McDonald

  3. Department of Pediatrics, Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Gregory P. Moore

  4. CHEO Research Institute, Ottawa, ON, Canada

    Gregory P. Moore

  5. Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada

    Gregory P. Moore

  6. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Gregory P. Moore

  7. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Sarah D. McDonald

Authors
  1. Alexandra Marseu
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  2. Pasqualina Santaguida
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  3. Gregory P. Moore
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  4. Sarah D. McDonald
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Contributions

AM was responsible for the data curation, formal analysis and writing of the original draft. AM and SDM led the project administration and visualization. PS was responsible for validation. Both PS and SDM were involved with conceptualization and funding acquisition. PS, GPM and SDM did the methodology. SDM was also responsible for supervision and resources. All authors were involved in the investigation and reviewed and edited the manuscript.

Corresponding author

Correspondence to Sarah D. McDonald.

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Competing interests

SDM is supported by a Tier II Canada Research Chair. The remaining authors report no conflict of interest.

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Marseu, A., Santaguida, P., Moore, G.P. et al. An e-Delphi study on mode of delivery and extremely preterm breech singletons. J Perinatol 43, 15–22 (2023). https://doi.org/10.1038/s41372-022-01458-7

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