Background: Evidence-based quality indicators are a reliable tool to objectively measure the degree in which the correct care is provided, given the current state of knowledge. Researchers and policy-makers may use them to compare performance of care over time in a single centre or between similar centres Objectives: To develop an evidence-based quality indicator set that measures the appropriateness of acute obstetric and delivery care in a hospital setting. Methods: We did a comprehensive search on the most important bibliographic sources (i.e. The Cochrane Library, Clinical Evidence and databases of clinical practice guidelines) to identify those therapeutic procedures for which a major recommendation (in favour or against) could be formulated based on high quality systematic reviews (SR). We used the GRADE instrument to assess the strength of recommendations. We followed a structured process that combined scientific evidence and expert advice to develop a quality indicator set based on the selected major recommendations for obstetric and delivery care. Results: We identified 303 SR, 48 of which were of high quality and assessed acute therapeutic procedures. Only 20 SR lead to a strong recommendation in clinical practice. Input from a group of experts led to the exclusion of two recommendations due to difficulties in applicability.We thus developed a total of 18 quality indicators: eight of them referred to prepartum care, eight referred to delivery, one referred to postpartum and one referred to incomplete miscarriage. These quality indicators were further tested for their validity in a pilot study of a random sample of 100 pregnant women seeking care in three hospitals. Conclusion: It is possible and feasible to develop evidence-based quality indicators to measure the appropriateness of care in Obstetrics. SR can provide an important source of evidence when developing indicators based on the current state of knowledge.