title: A literature review of quantitative indicators to measure the quality of labor and delivery care.
abstract: BACKGROUND
  Strengthening measurement of the quality of labor and delivery (L&D) care in low-resource countries requires an understanding of existing approaches.
  
  
  OBJECTIVE
  To identify quantitative indicators of L&D care quality and assess gaps in indicators.
  
  
  METHODS
  PubMed, CINAHL Plus, and Embase databases were searched for research published in English between January 1, 1990, and October 31, 2013, using structured terms.
  
  
  METHODS
  Studies describing indicators for L&D care quality assessment were included. Those whose abstracts contained inclusion criteria underwent full-text review.
  
  
  METHODS
  Study characteristics, including indicator selection and data sources, were extracted via a standard spreadsheet.
  
  
  RESULTS
  The structured search identified 1224 studies. After abstract and full-text review, 477 were included in the analysis. Most studies selected indicators by using literature review, clinical guidelines, or expert panels. Few indicators were empirically validated; most studies relied on medical record review to measure indicators.
  
  
  CONCLUSIONS
  Many quantitative indicators have been used to measure L&D care quality, but few have been validated beyond expert opinion. There has been limited use of clinical observation in quality assessment of care processes. The findings suggest the need for validated, efficient consensus indicators of the quality of L&D care processes, particularly in low-resource countries.
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; EngenderHealth, New York, NY, USA. Electronic address: vtripathi@engenderhealth.org.
authors.forename: Vandana
authors.initials: V
authors.lastname: Tripathi
mesh_terms: D036861:Delivery, Obstetric / Q000592:standards*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D019984:Quality Indicators, Health Care
keywords: Labor and delivery; Low-resource countries; Newborn care; Postpartum care; Quality indicators; Quality measurement; Quality of health care