Analysis of maternal deaths has been used for many year in the evaluation of the quality of obstetric care in both high and low income countries. The decreasing maternal mortality ratio in high income countries has resulted in the need for a more sensitive measure of quality of care such as severe maternal morbidity. The International Network of Obstetric Survey Systems (INOSS) is a multinational collaboration of organisations conducting prospective population-based studies of serious illnesses in pregnancy and childbirth. Many severe complications of pregnancy are uncommon and therefore difficult to study, and hence management is rarely based on robust evidence. The organisations participating in the network conduct high quality studies of these uncommon disorders on a regional, national and international basis.
The definitions of items of maternal morbidity can differ widely in the international scientific literature. It is therefore difficult to directly compare national studies of maternal morbidity with regard to incidence, management strategies and outcome. In order to promote future comparability of maternal morbidity as well as conduct collective studies, we will perform a Delphi into the definition of eight common items of morbidity. The Delphi will be conducted by experts from all INOSS member countries. The items in the Delphi process are: eclampsia, amniotic fluid embolism, peripartum hysterectomy, severe postpartum haemorrhage, uterine rupture, abnormally invasive placentation (AIP), spontaneous hemoperitoneum in pregnancy (SHiP) and cardiac arrest in pregnancy.
T.P. Schaap (UMC Utrecht, the Netherlands), K.W.M. Bloemenkamp (UMC Utrecht, the Netherlands), Catherine Deneux Tharaux (Inserm, France), Jens Langhoff-Roos (Rigshospitalet, Denmark), Marian Knight (NPEU, United Kingdom)
Disease Category: Pregnancy & childbirth
Disease Name: Maternal morbidity
Age Range: Unknown
Sex: Female
Nature of Intervention:
- Researchers
- Definition
- Consensus meeting
- Delphi process
All member countries of INOSS will supply five experts per item of morbidity from different specialities (e.g. obstetricians; anaesthesiologists; epidemiologists). Using an online survey tool all expert will supply their definition of the eight items of maternal morbidity. During the second and third round all experts will award Likert scales to the stated definitions (collected in the first round). During these 2nd and 3rd round, the measure of agreement of the definitions will be shown (anonymised but labelled by type of specialist). During the consensus meeting the definitions with be presented included the awarded Likert scales and agreement. A final scoring will be done to ascertain the definitive definitions of the eight items of morbidity.