"It's a breech, and what now?": A decision-aid tool to help clinicians counsel women with breech presentation near term

Objective: Management options for breech presentation near term include vaginal breech delivery, cesarean delivery, and external cephalic version. Shared decision-making in this context involves conveying detailed information about each procedure, including success rates, potential discomforts, risks, recovery periods, and necessary follow-up. The complexity of this information can make discussions challenging. Our goal was to develop a decision aid tool specifically for clinicians, aimed at facilitating shared decision-making with pregnant women who have breech presentations near term.

Methods: The decision aid tool was developed following a thorough literature review, and incorporated input from three clinical experts and a clinical communication psychologist. The document then underwent a two-round Delphi evaluation involving 18 experienced obstetricians from different hospitals, using a 5-point Likert scale ("strongly disagree" to "strongly agree"). Consensus was defined as more than 75% of participants responding "agree" or "strongly agree".

Results: A comprehensive tool providing information on clinical aspects derived from the most robust evidence, along with guidance on the steps involved in shared decision-making was constructed. The percent agreement in classes 4 ("agree") and 5 ("strongly agree") was 100 %, with a kappa of 1 (95 % CI, 1-1).

Conclusion: An innovative tool aimed at clinicians was developed to facilitate shared decision-making with pregnant women who have breech presentations near term. A strong consensus on the document́ content was achieved using the Delphi technique.

Synopsis: An innovative tool aimed at clinicians was developed to facilitate shared decision-making with pregnant women who have breech presentations near term.