Objective: To explore the impact of risk factors from three different time periods on negative birth experience. Design: Register-based cohort study. Setting: Sweden. Population: Nulliparous women giving birth to singleton, term infants in 2013–2018 (n = 83 335), elective caesarean sections (CS) excluded. Methods: Hierarchical logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) in three blocks, each representing risk factors from one of three time periods: I) before pregnancy, II) pregnancy, III) labour. Main Outcome Measurement: Negative birth experience, defined as ratings of ≤ 4 on a ten-point scale. Results: Poor self-rated health (SRH) was the only pre-gestational factor remaining associated with negative birth experience after adjustment for pregnancy- and labour-related factors (aOR 1.22, 95% CI 1.10–1.36). Fear of childbirth and treatment for psychiatric disorder during pregnancy were both associated with negative birth experience (aOR 1.53, 95% CI 1.36–1.73; aOR 1.51, 95% CI 1.35–1.68), as were all labour-related factors included in the model. Women giving birth by operative vaginal delivery or unplanned CS under regional anaesthesia had three-fold higher ORs for rating their overall birth experience as negative (aOR 3.23, 95% CI 2.99–3.50; aOR 3.04, 95% CI 2.77–3.33). The highest OR, 5.38, was seen among women undergoing unplanned CS under general anaesthesia (95% CI 4.52–6.40). Conclusions: The main contributing factors to a negative birth experience are labour-related. Poor SRH, psychiatric treatment and fear of childbirth places the woman in a vulnerable position requiring extra attention.

Objective To develop a Core Outcome Set (COS) for treatment of perinatal depression Design Systematic overview of outcomes reported in the literature and consensus development study using a Delphi survey and modified nominal group technique. Setting International. Population Two hundred and twenty-two participants, representing thirteen countries. Methods A systematic overview of outcomes reported in recently published research, a two-round Delphi survey, a consensus meeting at which the final COS was decided. Main results In the literature search, 1772 abstracts were identified and evaluated, 284 papers/protocols were assessed in full and 165 studies were finally included in the review. In all, 106 outcomes were identified and thus included in the Delphi survey. 222 participants registered for the first round of the Delphi survey and 151 (68%) responded. In the second round, 123 (55%) participants responded. The following 9 outcomes were agreed upon for inclusion in the final COS: self-assessed symptoms of depression, diagnosis of depression by a clinician, parent to infant bonding, self-assessed symptoms of anxiety, quality of life, satisfaction with intervention, suicidal thoughts, attempted or committed suicide, thoughts of harming the baby, and adverse events. Conclusions The relevant stakeholders prioritised outcomes and reached consensus on a COS comprising nine outcomes. We hope that this COS will contribute to consistency and uniformity of outcome selection and reporting in future clinical trials involving treatment of perinatal depression Funding This article is adapted from a report by SBU, which provided funding for the study. Keywords: perinatal depression, postpartum depression, antenatal depression, COS

Background: Systematic reviews of clinical trials frequently reveal heterogeneity in the number and types of outcomes reported. To counteract this, a Core Outcome Set (COS) may be applied. Objectives: A systematic review of all completed and ongoing COS related to pregnancy and childbirth Search strategy: COMET up to January 2020, Ovid MEDLINE, EMBASE, PsycINFO, Academic Search Elite, CINAHL and SocINDEX up to June 2019. Selection criteria: Studies which prioritized outcomes using some form of consensus method (such as the Delphi technique) were included. Data collection and analysis: All included studies were checked for compliance with the Core Outcome Set–STAndards for Reporting. Information about population, setting, method and outcomes was extracted. Main results: Nineteen completed studies and thirty-nine ongoing studies were included. The number of outcomes included in various COS ranged from 6 to 48. Most COS were for conditions related to physical complications during pregnancy. No COS were identified for perinatal mental health. Conclusion: This review discloses a growing number of COS within the field of pregnancy and childbirth. Many of the completed studies follow the proposed reporting. However, several of the COS included a large number of outcomes. There is a need to consider the number of outcomes which may be included in a COS while retaining its applicability in future research. Funding This article is adapted from a report undertaken by the SBU, who provided funding for the study. Keywords: Childbirth, Core outcome set, Maternal health, Obstetric care, Pregnancy