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

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.