Enhancing perinatal outcome evaluation with the Composite Adverse Perinatal Outcome (CAPO) index: A modified Delphi study

Abstract

Objective: To develop a perinatal outcomes measurement tool by extending the Weighted Adverse Outcome Score (WAOS). Methods: An open-ended survey of five experienced experts was conducted to compile an initial list of WAOS extension components in the preliminary round, and the results were consolidated to form a Delphi questionnaire. A two-round modified e-Delphi survey of 29 obstetricians, neonatologists, scientists, and policymakers was conducted. During Delphi rounds, panelists rated the importance, scientific evidence, and feasibility of the proposed component. Severity scores were also assigned based on the WAOS criteria. After consensus was reached, the extension components were integrated with the original WAOS to create the Composite Adverse Perinatal Outcome (CAPO). Results: In the preliminary round, an initial list of nine potential extension outcomes for WAOS was proposed. Six outcomes were further proposed after Delphi round 1. Consensus was reached after two Delphi rounds, resulting in 13 additional outcomes apart from WAOS. Each outcome was assigned a severity score ranging from 75 to 490 points. The final CAPO included seven maternal outcomes (postpartum hemorrhage, severe pre-eclampsia, deep vein thrombosis, disseminated intravascular coagulation, amniotic fluid embolism, placenta previa, morbidly adherent placenta) and six neonatal outcomes (preterm birth, low birth weight, meconium peritonitis, meconium aspiration syndrome, congenital malformation, neonatal sepsis), in addition to the 10 outcomes included in the WAOS. Conclusions: Our study developed the CAPO index, which includes 23 maternal and neonatal outcomes, for a comprehensive evaluation of perinatal health. Further implementation and validation in clinical and research settings are anticipated.