Variations in caesarean section outcome reporting in low- and middle-income countries: A systematic review

Objective: To explore the variation and quality of the outcomes reported using descriptive analysis and interactive network visualisation of CS outcomes of comparative studies conducted in low-and middle-income settings. Study Design: Systematic review of comparative studies to reduce caesarean section complications in low- and middle-income countries and outcome assessment using the modified Harman questionnaire, assessing for the presence of a clear primary outcome, an explanation of how the outcomes were analysed and a description of the methods used to enhance the quality of these measures. Results: 102 comparative studies were included. Studies of interventions to improve maternal and perinatal outcomes after caesarean section reported 466 outcomes with 15 % of these outcomes appearing only once across the outcomes reviewed (n = 73). The most common outcome categories reported were maternal death, disability and bleeding. Psychological and injury outcomes were less commonly reported. The overall quality of outcome reporting varied between studies but was particularly low for reporting on methods to improve outcome measures. Very few outcomes scored a maximum of three points when assessed according to the modified Harman score, with only 15 of the primary outcomes (16 %) achieving 3 points and 40 of the secondary outcomes (11 %) achieving 3 points. The median quality of reporting was 2 (range 0, 3) for all outcomes, for a maximum score of 3. Quality of outcome reporting was associated with the type of outcome (primary or secondary), the region in which the study was conducted in, and journal characteristics such as impact factor and journal type. Conclusions: There was wide variability in both the outcomes reported and the frequency in which they were reported. Overall, very few primary and secondary outcomes achieved the maximum score of three on the modified Harman score, highlighting the need for a core outcome set for caesarean section intervention trials to improve the consistency and synergy of future research outcome definition, measurement and synthesis. Trial registration: The protocol was registered (PROSPERO CRD42022353939)