Clinician Delphi on mode of delivery in extremely preterm breech singletons

Objectives Our study aimed to understand the attitudes and practices of clinicians in the care of extremely preterm breech singletons and to assess knowledge about survival and neurodevelopmental outcomes of extremely preterm infants. Methods Canadian clinicians who provided obstetrical/newborn care in the past two years were recruited to a two round Delphi, a structured, iterative process using multiple rounds of clinical vignettes to gather information about clinician practices and to understand where consensus (defined as 75% agreement) on management was possible. We also assessed knowledge about neonatal outcomes. Results The Delphi's 87 participants demonstrated significant variation in the management of extremely preterm breech pregnancies. When asked how likely or unlikely they were to offer cesarean section in 12 scenarios with various maternal, fetal and gestational age factors, clinicians achieved consensus in only four of 12 scenarios in round one and three scenarios in round two. Secondly, clinicians significantly underestimated neonatal survival and neurodevelopmental outcomes. Many felt that there is a lack of awareness of and ease of accessibility of the current data. Conclusions The care of extremely preterm breech singletons is variable among Canadian clinicians, emphasizing the importance of parental involvement in decision making about mode of birth. There is also a need to facilitate clinicians’ uptake of current data given the underestimation of survival and neurodevelopmental outcomes. The information gained from this Delphi will guide the development of a shared-decision making tool for parents and clinicians for mode of delivery in extremely preterm breech singletons, enabling provision of patient-centred care.