Comparing apples and oranges? Variation in choice and reporting of short-term perinatal outcomes of term labor: A systematic review of Cochrane reviews.

Obstetric research is often criticized for using surrogate or combined outcomes with a disproportionately heavy weight of less relevant components. The objective of this methodological systematic review was to assess the choice and reporting of short-term perinatal outcomes for management of labor at or near term and evaluate if there is any need and possibility to harmonize them. A systematic methodological review of Cochrane reviews was performed. The review was registered prospectively at International Prospective Register of Systematic Reviews (PROSPERO), registration number212954. The Cochrane Database of Systematic Reviews was searched by topics and group browsing and by combination of free-text words and standardized subject terms. Cochrane Systematic Reviews with focus on management of labor at or near term, including timing, type of labor onset, mode of delivery and intrapartum care were included while those focused on prenatal care, postnatal interventions, and preterm deliveries were excluded. Prespecified and reported non-prespecified short-term perinatal (foetal and newborn) outcomes were collected. The outcomes were grouped into domains and classified independently by two authors into five prespecified groups regarding their anticipated importance for patients. Outcomes reflecting how a patient feels, functions, and survives were deemed patient-important. We also evaluated whether any of the outcomes were salutogenic (reflecting positive health and well-being rather than illness or adverse event prevention or avoidance). Our search resulted in 806 Cochrane Systematic Reviews, of which we included 141 published between the years 1996 and 2020. We identified 348 unique outcomes, of which 15 (4.3%) were prespecified and 13 (3.7%) were reported in at least 10% of the reviews. Only half of the prespecified outcomes were reported. In total, 88 (25.3%) of the 348 outcomes were classified as patient important, reflecting how a patient feels, functions, and survives. Salutogenic outcomes were rare (3.4%). To conclude, variation in the choice of outcomes for management of term labor as well as the discrepancy between chosen and reported outcomes were large. Harmonization of perinatal outcome measures, based on consensus between researchers, clinicians, and families, is needed.