1. Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity
- Author
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Serena Donati, Marcus Rijken, William Parsonage, David Ellwood, Elizabeth Sullivan, Lone Krebs, Michael Peek, Shilpanjali Jesudason, Elena Kuklina, Caroline Daelemans, Lucy Mackillop, Amsterdam Reproduction & Development (AR&D), Obstetrics and gynaecology, and ACS - Atherosclerosis & ischemic syndromes
- Subjects
Embolism, Amniotic Fluid ,medicine.medical_specialty ,Consensus ,Placenta Diseases ,Delphi Technique ,Quality Assurance, Health Care ,International studies ,International Cooperation ,Population ,education ,Pregnancy Complications, Cardiovascular ,Delphi method ,Hysterectomy ,Severity of Illness Index ,Likert scale ,03 medical and health sciences ,Amniotic fluid embolism ,0302 clinical medicine ,Obstetrics and gynaecology ,Uterine Rupture ,Pregnancy ,Outcome Assessment, Health Care ,medicine ,Humans ,Eclampsia ,computer.programming_language ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Developed Countries ,Postpartum Hemorrhage ,Obstetrics and Gynecology ,medicine.disease ,Heart Arrest ,Pregnancy Complications ,Family medicine ,Hemoperitoneum ,Female ,business ,computer ,Delphi - Abstract
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.
- Published
- 2017