How safe is it to plan a vaginal breech birth with OptiBreech collaborative care?: analysis of cumulative data within the OptiBreech Multiple Trials Cohort

<ns3:p>Background OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term. The OptiBreech Multiple Trial Cohort is designed to host multiple trials related to care for breech presentation. This design enables prospective data collection for a large cohort of women planning a vaginal breech birth (VBB), to assess rare safety outcomes, while answering questions requiring a smaller, randomised sample nested within this cohort. Methods OptiBreech database currently contains participants recruited from January 2022 to January 2024, including 67 women randomised to either OptiBreech care or standard care, and 147 women who received OptiBreech care and were not randomised. Primary outcomes included vaginal birth rate, composite neonatal morbidity and mortality and composite maternal neonatal morbidity and mortality. Descriptive statistics for the entire cohort were analysed in SPSS Version 29. Sub-group analyses were identified through participant involvement and engagement work as important to support informed decision-making. Results Of 117 women who planned a VBB at any point, 54 (46.2%) achieved a vaginal birth, compared to 36/96 (37.5%) of women who did not plan a VBB. Admission rates to a neonatal unit were similar, 5/117 (4.3%) versus 4/96 (4.2%). In this cohort, there was no severe neonatal morbidity following planned VBB, compared to 3/96 (3.1%) among the cohort who did not plan a vaginal breech birth and 2/61 (3.3%) among women who planned a cephalic birth after spontaneous or external cephalic version. Severe maternal morbidity following planned VBB was 12/115 (10.4%), compared to 9/95 (9.5%) for women who did not plan a VBB and 9/61 (14.8%) for women who planned a cephalic birth. Conclusions Planning a VBB with OptiBreech collaborative care has thus far been as safe as not planning a VBB. Detecting differences in rare outcomes will require thousands of births. This report includes all outcomes reported during OptiBreech feasibility work. Further research will depend on future substantive funding.</ns3:p>