Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity
Schaap, T; Bloemenkamp, K; Deneux-Tharaux, C; Knight, M; Langhoff-Roos, J; Sullivan, E; van den Akker, T; INOSS
(2019) BJOG - An International Journal of Obstetrics and Gynaecology, volume 126, issue 3, pp. 394 - 401
(Article)
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.
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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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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, Abnormally invasive placentation, Obstetrics and Gynaecology, Journal Article
ISSN: 1470-0328
Publisher: Wiley-Blackwell
Note: Funding Information: No funding was received. The authors thank the INOSS members for their advice on study design and interpretation of results. We also thank the following experts for their input during the Delphi process: Agn?s Rigouzzo, Alexandra Kristufkova, Andreea Creanga, Ankie Koopman- Van Gemert, Anna-Maija Tapper, Anneke Dijkman, Anneke Kwee, Arie Franx, Bas Veersema, Bianka Nemethova, Birgit Seelbach-G?bel, Brian Bateman, Caroline Daelemans, Carolyn Zelop, Charlotte Brix Andersson, Chie Nagata, Cindy Farquhar, Claartje Huisman, Constantin von Kaisenberg, Dacia Henriquez, David Ellwood, David Moolenaar, Derek Tuffnell, Elena Kuklina, Elliott Main, Erica Woods, Eva Stekkinger, Evelina Gollo, Fran?ois Goffinet, Franz Kainer, Gerald Mantel, Giel Stralen, Gilles Kayem, Hans Duvekot, HeikoB. G. Franz, Hilde Engjom, Ingrid Beenakkers, Iqbal Al-Zirqi, Jakub Danis, Janne Foss Berlac, Jenny Kurinczuk, Jens Langhof-Roos, Joost Zwart, Jos Roosmalen, Kari Klungsor, Karin Lust, Kitty Bloemenkamp, Klaus Vetter, Kristel Van Calsteren, Kristien Roelens, Lone Krebs, Lotte Berdiin Colmorn, Lucy MacKillop, Mamoru Tanaka, Marcus Rijken, Marian Knight, Marie-Pierre Bonnet, Marjon De Boer, Mervi Jokinen, Michael Belfort, Michael Peek, Mika Gisler, Mike Foley, Minna Tikkanen, Miroslav Korbel, Monika Dugatova, Monika Laubach, Nico Schuitemaker, Nicole Engel, Nolan McDonnell, Patrick Emonts, Patrick Rozenberg, Peter Hillemanns, R?diger Rauskolb, Satoru Takeda, Serena Donati, Sergio Ferrazzani, Shigeki Matsubara, Shigeru Saito, Shilpanjali Jesudason, Shoji Satoh, Siri Vangen, Steven Clark, Steven Koenen, Susanne Gr??ner, Susumu Miyashita, Thomas Van den Akker, Thorsten Fischer, Tullia Todros, Tullia Todros, Valerie Harskamp, Velja Mijatovic, Vittorio Basevi, Wendy Pollock, William Callaghan, William Parsonage, Wolfgang Henrich, Xandra Schyns, Yasuyuki Fujita, Yoshio Matsuda, Yves Garnier, Zentner Dominica. Publisher Copyright: © 2017 Royal College of Obstetricians and Gynaecologists Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
(Peer reviewed)