Monitoring childbirth and immediate postpartum care quality: A scoping review of indicators in high-income countries
Abstract
Background: Most maternal and neonatal morbidity and mortality occur during childbirth and the immediate postnatal period. In high-income countries, where most births occur in maternity units, systematic monitoring of care quality is essential to improve safety and reduce preventable adverse outcomes. Objective: To identify maternal and neonatal indicators of quality-of-care at childbirth and immediate postnatal period in high-income countries, and to assess their level of validity. Methods: This scoping review followed PRISMA-ScR guidelines. A systematic search was conducted in April 2024 (updated March 2025) in Medline, Embase, CINAHL, and Web of Science. Eligible studies included literature from high-income countries reporting quality-of-care indicators. Indicators were extracted as reported and consolidated: those with aligned definitions were clustered into standardised indicators and subsequently grouped into broader constructs reflecting key dimensions of care. Indicators were grouped into four domains (access, structure, process, and outcome) and evaluated using a structured validity scoring system. Indicators were classified as high-validity if they included a clear definition (with specified numerator and denominator) and achieved a validity score of 3 or 4 on a 0–4 scale. Results: Eighty-four studies were included. In total, 981 individual indicators were identified; 546 were clearly defined and consolidated into 214 standardised indicators and 61 indicator constructs. Most focused on outcomes (n = 253, 46.3%) and processes (n = 243, 44.5%), with substantial heterogeneity in definitions. Fewer indicators addressed structure (n = 47, 8.6%) and access (n = 3, 0.6%). Nearly one third of all indicators demonstrated high-validity, mainly within outcome and process domains. Conclusions: This review identified a large set of quality-of-care indicators, reflecting sustained efforts to monitor care around childbirth. However, heterogeneity in definitions and variable validation limit comparability and routine use. These findings highlight the need for greater validation and standardisation of indicators, followed by the prioritisation of high-validity measures to support meaningful quality monitoring and improvement.
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BibTeX
@article{warren2026monitoring,
title = {{Monitoring childbirth and immediate postpartum care quality: A scoping review of indicators in high-income countries}},
author = {M. Allison Warren and Dayana Hamparsoumian and Elsa Lorthe and Gilles Cattani and Francisca Barcos Munoz and David Baud and Caroline Daelemans and Pauline de Vries and Manuella Epiney and Emanuela Gerhard and Markus Hodel and Marzia Loghi and Begoña Martinez de Tejada and Raegan Macstravic and Beatrice Mosimann and Marianne Philibert and Tonia Rihs and Anne Steiner and Laurent Gaucher and Thomas Desplanches},
journal = {PLoS ONE},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0350665},
url = {https://univ-lyon1.hal.science/hal-05756066v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Monitoring childbirth and immediate postpartum care quality: A scoping review of indicators in high-income countries
AU - M. Allison Warren
AU - Dayana Hamparsoumian
AU - Elsa Lorthe
AU - Gilles Cattani
AU - Francisca Barcos Munoz
AU - David Baud
AU - Caroline Daelemans
AU - Pauline de Vries
AU - Manuella Epiney
AU - Emanuela Gerhard
AU - Markus Hodel
AU - Marzia Loghi
AU - Begoña Martinez de Tejada
AU - Raegan Macstravic
AU - Beatrice Mosimann
AU - Marianne Philibert
AU - Tonia Rihs
AU - Anne Steiner
AU - Laurent Gaucher
AU - Thomas Desplanches
PY - 2026
DA - 2026/09/15
JO - PLoS ONE
DO - 10.1371/journal.pone.0350665
UR - https://univ-lyon1.hal.science/hal-05756066v1
AB - Background: Most maternal and neonatal morbidity and mortality occur during childbirth and the immediate postnatal period. In high-income countries, where most births occur in maternity units, systematic monitoring of care quality is essential to improve safety and reduce preventable adverse outcomes. Objective: To identify maternal and neonatal indicators of quality-of-care at childbirth and immediate postnatal period in high-income countries, and to assess their level of validity. Methods: This scoping review followed PRISMA-ScR guidelines. A systematic search was conducted in April 2024 (updated March 2025) in Medline, Embase, CINAHL, and Web of Science. Eligible studies included literature from high-income countries reporting quality-of-care indicators. Indicators were extracted as reported and consolidated: those with aligned definitions were clustered into standardised indicators and subsequently grouped into broader constructs reflecting key dimensions of care. Indicators were grouped into four domains (access, structure, process, and outcome) and evaluated using a structured validity scoring system. Indicators were classified as high-validity if they included a clear definition (with specified numerator and denominator) and achieved a validity score of 3 or 4 on a 0–4 scale. Results: Eighty-four studies were included. In total, 981 individual indicators were identified; 546 were clearly defined and consolidated into 214 standardised indicators and 61 indicator constructs. Most focused on outcomes (n = 253, 46.3%) and processes (n = 243, 44.5%), with substantial heterogeneity in definitions. Fewer indicators addressed structure (n = 47, 8.6%) and access (n = 3, 0.6%). Nearly one third of all indicators demonstrated high-validity, mainly within outcome and process domains. Conclusions: This review identified a large set of quality-of-care indicators, reflecting sustained efforts to monitor care around childbirth. However, heterogeneity in definitions and variable validation limit comparability and routine use. These findings highlight the need for greater validation and standardisation of indicators, followed by the prioritisation of high-validity measures to support meaningful quality monitoring and improvement.
SN - 1932-6203
SN - 1932-6203
ER -