Effectiveness and evidence-based practices in maternal care bundles for labour and birth: a systematic review protocol

Abstract

Introduction: Worldwide, maternal mortality is mostly caused by avoidable or treatable health complications, despite the progress made in maternal health. High-quality care focuses on a standardised and patient-centred approach. In this light, care bundles, which are sets of evidence-based practices, were introduced to improve the quality of care and maternal outcomes. The existing reviews on care bundles focus on specific conditions, and there is, to our knowledge, no comprehensive systematic review on the effectiveness and evidence-based character of care bundles on multiple maternal outcomes. This systematic review aims to describe maternal care bundles on labour and birth, to assess their effectiveness on maternal outcomes and to evaluate the evidence-based character of their interventions.

Methods and analysis: This systematic review will include randomised controlled trials, quasi-randomised studies, cohort studies, case-control studies, controlled before-and-after studies and interrupted-time-series studies, starting from 2001, focused on labour and childbirth stages, addressing care bundles that include multiple conditions. The search strategy will include six electronic databases (PubMed, Cochrane Library, CINAHL, Embase, Scopus and Web of Science) used to retrieve relevant titles and abstracts based on a database-specific search strategy. Titles and abstracts will be independently screened by two reviewers, followed by a full-text eligibility assessment. Reviewers will also extract data based on this review's objectives and outcomes. Analysis will be performed in three phases: descriptive analysis, evaluation of the evidence-based character of interventions and quantitative synthesis analysis.

Ethics and dissemination: Ethics approval is not needed. Dissemination will be performed through publication in peer-reviewed journals, conference presentations and informing policies and stakeholders by offering a structured overview of maternal care bundles on labour and childbirth.

Prospero registration number: PROSPERO 2025 CRD420251081127.

Keywords: Cesarean Section; Delivery of Health Care, Integrated; Maternal medicine; Natural Childbirth; Postpartum Women; Pregnant Women.

Figure 1. PICO strategy. PICO, population, intervention, comparison and outcome.