Quality assessment
The outcome quality was scored according to the MOMENT criteria (Management of otitis media with effusion in cleft palate score system) in a 6-point scale. The MOMENT criteria is a validated checklist used for quality assessment at study level which has been employed in a previous core outcome set development for women’s health and asks the following 16, 17: was a primary outcome stated (one point); was the primary outcome clearly defined for reproducible measures (one point); were the secondary outcomes clearly stated (one point); were the secondary outcomes clearly defined for reproducible measures (one point); do the authors explain the choice of outcome (one point); and are the methods used designed to enhance quality of measures appropriate (one point) 18. High quality was determined for studies that reached score 4 or more in these criteria. Although composite outcomes were recorded, they were not scored as primary outcomes because they are known to be frequently unreasonably combined, inconsistently defined and inadequately reported19.
For this review, the studies were not excluded based on their quality as the aim of this review was not to assess efficacy or causal associations of mode of birth on outcomes, but simply to provide a summary of outcomes reported in previous studies, and therefore was not considered to be affected by study quality.