OBJECTIVE: To assess patients' preferences and trade-offs for mode of delivery in case of breech presentation at term. METHODS: Eighty women (40 with a foetus in breech presentation and 40 with a foetus in cephalic presentation) with a gestational age from 36 weeks onwards were offered scenarios of vaginal and caesarean breech delivery in which 1-month and 2-year neonatal and maternal complication rates were varied; expectant fathers (when present) were interviewed separately. Thresholds for complication rates where patients switch preferences were visualised graphically in trade-off curves. Differences in preference thresholds were tested using the Wilcoxon signed ranks test. RESULTS: Caesarean delivery was the preferred mode of delivery for breech presentation in 65% of the patients interviewed. The trade-off questions showed that the 2-year neonatal outcome after breech delivery was the most important outcome for the mothers, whereas the fathers were more influenced by the maternal outcome. CONCLUSION: When realistic assumptions for complications are made, most women prefer a caesarean delivery over vaginal delivery for at term breech presentation. In the balance of pros and cons, 2-year neonatal outcome is the most important factor in the decision between caesarean and vaginal delivery. PRACTICE IMPLICATIONS: The results of this study can be used by the clinician to help patients weigh risk, benefit, and potential harm with regard to breech delivery.
OBJECTIVE: To assess patients' preferences and trade-offs for mode of delivery in case of breech presentation at term. METHODS: Eighty women (40 with a foetus in breech presentation and 40 with a foetus in cephalic presentation) with a gestational age from 36 weeks onwards were offered scenarios of vaginal and caesarean breech delivery in which 1-month and 2-year neonatal and maternal complication rates were varied; expectant fathers (when present) were interviewed separately. Thresholds for complication rates where patients switch preferences were visualised graphically in trade-off curves. Differences in preference thresholds were tested using the Wilcoxon signed ranks test. RESULTS: Caesarean delivery was the preferred mode of delivery for breech presentation in 65% of the patients interviewed. The trade-off questions showed that the 2-year neonatal outcome after breech delivery was the most important outcome for the mothers, whereas the fathers were more influenced by the maternal outcome. CONCLUSION: When realistic assumptions for complications are made, most women prefer a caesarean delivery over vaginal delivery for at term breech presentation. In the balance of pros and cons, 2-year neonatal outcome is the most important factor in the decision between caesarean and vaginal delivery. PRACTICE IMPLICATIONS: The results of this study can be used by the clinician to help patients weigh risk, benefit, and potential harm with regard to breech delivery.
Authors: Saskia Hendriks; Christine Grady; David Wasserman; David Wendler; Diana W Bianchi; Benjamin E Berkman Journal: Am J Bioeth Date: 2021-01-16 Impact factor: 11.229
Authors: S Derisbourg; E Costa; L De Luca; S Amirgholami; V Bogne Kamdem; A Vercoutere; W H Zhang; S Alexander; P M Buekens; Y Englert; A Pintiaux; C Daelemans Journal: BMC Pregnancy Childbirth Date: 2020-07-29 Impact factor: 3.007
Authors: Maarten D H Vink; Piet J G M de Bekker; Xander Koolman; Maurits W van Tulder; Ralph de Vries; Ben Willem J Mol; Eric J E van der Hijden Journal: BMC Pregnancy Childbirth Date: 2020-08-20 Impact factor: 3.007