Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity

INOSS, T. Schaap, K. Bloemenkamp, C. Deneux-Tharaux, M. Knight, J. Langhoff-Roos, E. Sullivan, T. van den Akker, Agnès Rigouzzo, Alexandra Kristufkova, Andreea Creanga, Ankie Koopman, Van Gemert, Anna Maija Tapper, Anneke Dijkman, Anneke Kwee, Arie Franx, Bas Veersema, Bianka Nemethova, Birgit Seelbach-Göbel & 31 others Brian Bateman, Caroline Daelemans, Carolyn Zelop, Charlotte 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, François Goffinet, Franz Kainer, Gerald Mantel, Giel Stralen, Gilles Kayem, Hans Duvekot, Heiko B.G. Franz, Hilde Engjom, Ingrid Beenakkers, Iqbal Al-Zirqi, Jakub Danis, Foss Berlac, Jenny Kurinczuk, Shilpanjali Jesudason

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

LanguageEnglish
Pages394-401
Number of pages8
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume126
Issue number3
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • Abnormally invasive placentation
  • Delphi
  • amniotic fluid embolism
  • cardiac arrest in pregnancy
  • eclampsia
  • pregnancy-related hysterectomy
  • severe acute maternal morbidity
  • severe primary postpartum haemorrhage
  • spontaneous hemoperitoneum in pregnancy
  • uterine rupture

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{99495c0f7c80437693a5dcfbb849d830,
title = "Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity",
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.",
keywords = "Abnormally invasive placentation, Delphi, amniotic fluid embolism, cardiac arrest in pregnancy, eclampsia, pregnancy-related hysterectomy, severe acute maternal morbidity, severe primary postpartum haemorrhage, spontaneous hemoperitoneum in pregnancy, uterine rupture",
author = "INOSS and T. Schaap and K. Bloemenkamp and C. Deneux-Tharaux and M. Knight and J. Langhoff-Roos and E. Sullivan and {van den Akker}, T. and Agn{\`e}s Rigouzzo and Alexandra Kristufkova and Andreea Creanga and Ankie Koopman and Van Gemert and Tapper, {Anna Maija} and Anneke Dijkman and Anneke Kwee and Arie Franx and Bas Veersema and Bianka Nemethova and Birgit Seelbach-G{\"o}bel and Brian Bateman and Caroline Daelemans and Carolyn Zelop and Charlotte Andersson and Chie Nagata and Cindy Farquhar and Claartje Huisman and {von Kaisenberg}, Constantin and Dacia Henriquez and David Ellwood and David Moolenaar and Derek Tuffnell and Elena Kuklina and Elliott Main and Erica Woods and Eva Stekkinger and Evelina Gollo and Fran{\cc}ois Goffinet and Franz Kainer and Gerald Mantel and Giel Stralen and Gilles Kayem and Hans Duvekot and Franz, {Heiko B.G.} and Hilde Engjom and Ingrid Beenakkers and Iqbal Al-Zirqi and Jakub Danis and Foss Berlac and Jenny Kurinczuk and Shilpanjali Jesudason",
year = "2019",
month = "2",
day = "1",
doi = "10.1111/1471-0528.14833",
language = "English",
volume = "126",
pages = "394--401",
journal = "BJOG: An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
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T1 - Defining definitions

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

AU - INOSS

AU - Schaap, T.

AU - Bloemenkamp, K.

AU - Deneux-Tharaux, C.

AU - Knight, M.

AU - Langhoff-Roos, J.

AU - Sullivan, E.

AU - van den Akker, T.

AU - Rigouzzo, Agnès

AU - Kristufkova, Alexandra

AU - Creanga, Andreea

AU - Koopman, Ankie

AU - Gemert, Van

AU - Tapper, Anna Maija

AU - Dijkman, Anneke

AU - Kwee, Anneke

AU - Franx, Arie

AU - Veersema, Bas

AU - Nemethova, Bianka

AU - Seelbach-Göbel, Birgit

AU - Bateman, Brian

AU - Daelemans, Caroline

AU - Zelop, Carolyn

AU - Andersson, Charlotte

AU - Nagata, Chie

AU - Farquhar, Cindy

AU - Huisman, Claartje

AU - von Kaisenberg, Constantin

AU - Henriquez, Dacia

AU - Ellwood, David

AU - Moolenaar, David

AU - Tuffnell, Derek

AU - Kuklina, Elena

AU - Main, Elliott

AU - Woods, Erica

AU - Stekkinger, Eva

AU - Gollo, Evelina

AU - Goffinet, François

AU - Kainer, Franz

AU - Mantel, Gerald

AU - Stralen, Giel

AU - Kayem, Gilles

AU - Duvekot, Hans

AU - Franz, Heiko B.G.

AU - Engjom, Hilde

AU - Beenakkers, Ingrid

AU - Al-Zirqi, Iqbal

AU - Danis, Jakub

AU - Berlac, Foss

AU - Kurinczuk, Jenny

AU - Jesudason, Shilpanjali

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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.

KW - Abnormally invasive placentation

KW - Delphi

KW - amniotic fluid embolism

KW - cardiac arrest in pregnancy

KW - eclampsia

KW - pregnancy-related hysterectomy

KW - severe acute maternal morbidity

KW - severe primary postpartum haemorrhage

KW - spontaneous hemoperitoneum in pregnancy

KW - uterine rupture

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U2 - 10.1111/1471-0528.14833

DO - 10.1111/1471-0528.14833

M3 - Article

VL - 126

SP - 394

EP - 401

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 3

ER -