Am J Perinatol 2020; 37(04): 436-452
DOI: 10.1055/s-0039-1681095
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Developing a Core Outcome Set for Cesarean Delivery Maternal Infectious Morbidity Outcomes

Kristin E. Briscoe
1  Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
David M. Haas
1  Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Further Information

Publication History

11 December 2018

25 January 2019

Publication Date:
28 February 2019 (online)


Objective This study aimed to develop a core outcome set of primary outcomes for studies involving cesarean deliveries with infectious morbidity outcomes.

Study Design Authors reported primary outcomes from 11 Cochrane systematic reviews (SRs), 12 other SRs, and 327 randomized controlled trials (RCTs). These outcomes were condensed into 20 primary outcome groups. Next, a modified Delphi technique was used to gain consensus on key outcomes. Authors from included SRs were sent a questionnaire consisting of a free response and multiple-choice questions. These data were used to propose a set of core outcomes.

Results The most frequent outcomes in RCTs were composite “infectious outcomes” (24%) with the second most common being endometritis (12%). The most common reported SR outcomes were wound infection (21%) and endometritis (16%). For the Delphi survey free response portion, wound infection (88%) and endometritis (79%) were the most commonly endorsed outcomes. Chosen list outcomes were maternal mortality (83%), wound infection (83%), wound complications (86%), and postpartum endometritis (80%). The proposed final core outcome set for cesarean trials was endometritis (primary outcome), maternal mortality, wound infection, wound complications, febrile morbidity, and neonatal morbidity.

Conclusion Utilizing defined core outcomes in all studies of cesarean section can harmonize trial reports and allow data synthesis for meta-analyses.

Authors' Contribution

Both authors conceived of the project, wrote the protocol, identified and abstracted information from studies, conceived of and implemented the various surveys, analyzed data, and prepared the final manuscript.


Part of this work was presented as an oral presentation at the 2016 Central Association of Obstetricians and Gynecologists Annual Meeting in Las Vegas, NV.

Ethical Approval

This study was approved by the governing Indiana University-IUPUI IRB, protocol #1509104479 (Approved 9/23/2015).

Supplementary Material