Identification of Essential Steps in Outlet Forceps-Assisted Vaginal Delivery: A Delphi Study.

Objective: To achieve expert consensus using the Delphi methodology on the sub-steps considered essential in an outlet forceps-assisted vaginal delivery (FAVD). The purpose of this work is to help inform a framework for standardized training and objective assessment in the procedure.

Methods: A Delphi survey was conducted with an international panel of experts in FAVD. Using an online platform, experts rated sub-steps of FAVD on a 5-point Likert scale to indicate whether they considered them essential. Responses were returned to the panel until consensus was reached (Cronbach α ≥ 0.80) with an intraclass correlation coefficient ≥0.75. All sub-steps with a rate of agreement ≥80% are proposed to be included in a future evaluation instrument.

Results: After the first iteration of the Delphi procedure, a response rate of 42% was reached (n = 21); the second iteration was only sent to those who had participated in the initial iteration, reaching a response rate of 100%. Of 42 sub-steps rated in the first round, 24 (57.1%) achieved consensus, 8 (19%) were rejected, and 10 (23.8%) were re-rated in the second round. After 2 iterations, 28 sub-steps were agreed upon by the experts to be essential in FAVD.

Conclusions: A panel of experts identified a total of 28 sub-steps essential to FAVD. This list could inform the development of an objective assessment framework and evaluation tool for this procedure. Further research should focus on the standardization, applicability, validation, and introduction of this tool in medical training, with a focus on real-life, high-fidelity simulation and online educational tools.