Journal
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume 126, Issue 3, Pages 394-401Publisher
WILEY
DOI: 10.1111/1471-0528.14833
Keywords
Abnormally invasive placentation; amniotic fluid embolism; cardiac arrest in pregnancy; Delphi; eclampsia; pregnancy-related hysterectomy; severe acute maternal morbidity; severe primary postpartum haemorrhage; spontaneous hemoperitoneum in pregnancy; uterine rupture
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Funding
- Department of Health [PDA/02/06/044] Funding Source: Medline
- National Institutes of Health Research (NIHR) [PDA/02/06/044] Funding Source: National Institutes of Health Research (NIHR)
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Objective Develop a core outcome set of international consensus definitions for severe maternal morbidities. Design Electronic Delphi study. Setting International. Population Eight expert panels. Methods All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. Main outcome measures Definitions with a rate of agreement of more than 70%. Results The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. Conclusion Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. Tweetable abstract Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.
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