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Published on: January 12, 2018
Clinical guidelines for prevention and management of preterm birth: a systematic review
N Medley1, B Poljak1, S Mammarella2
1Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK.
Insights
International guidelines agree on interventions to prevent preterm birth (PTB), including cervical screening and fetal lung maturation steroids. However, recommendations vary for progesterone and strategies for multiple pregnancies remain unclear.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Clinical Practice Guideline Development
Background:
- Clinical practice guidelines (CPG) offer various strategies for preventing and managing preterm birth (PTB).
- International consensus on PTB interventions is crucial for standardized care.
Purpose of the Study:
- To summarize CPG recommendations for PTB.
- To identify areas of international consensus on PTB prevention and management strategies.
Main Methods:
- A comprehensive search for CPG related to PTB was conducted in May 2017.
- Eligible CPGs published or current from June 2013 were selected based on recommendations for screening, medications, surgery, and other interventions.
- Two authors classified recommendations, defining consensus as agreement by over 70% of CPGs on a specific intervention.
Main Results:
- 49 guidelines from 16 developers were identified.
- Consensus was found for cervical length screening in high-risk women, short-term tocolysis, steroids for fetal lung maturation, and magnesium sulfate for fetal neuroprotection.
- Discrepant recommendations were noted for progesterone and fibronectin; no effective strategy was identified for multiple pregnancies.
Conclusions:
- International clinical guidelines show agreement on the benefits and harms of key interventions for PTB.
- Standardized systematic reviews of CPGs can prevent duplication and optimize resource allocation for guideline development globally.
Background:
Clinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB).
Objectives:
To summarise CPG recommendations for PTB and identify areas of international consensus.
Search Strategy:
In May 2017 we searched for all CPG relevant to PTB without language restrictions.
Selection Criteria:
CPG were eligible if the following criteria were met: (1) the guideline was published or current from June 2013; (2) the guideline recommended practices for the prevention or management of PTB relevant to our prespecified clinical questions for screening, medications or surgery and other interventions; (3) publications on methods of guideline development for eligible CPG were included to enable quality assessment.
Data Collection And Analysis:
Two authors classified CPG recommendations relevant to prespecified clinical questions. When more than 70% of CPGs reporting on a topic recommended or rejected an intervention, we regarded this as consensus. We summarised recommendations in tables.
Main Results:
We identified 49 guidelines from 16 guideline developers. We found consensus for several clinical practices: cervical length screening for high-risk women; short-term tocolysis; steroids for fetal lung maturation; and magnesium sulphate for fetal neuroprotection. We found discrepant recommendations for progesterone and fibronectin. No guideline identified an effective strategy for women with multiple pregnancy.
Conclusions:
We identified interventions for which there is an international consensus on benefit for PTB. Systematic reviews of CPG using standardised methodology will help avoid duplication and target scarce resources for guideline developers globally.
Tweetable Abstract:
International clinical guidelines agree on the benefits and harmful effects of several important interventions to prevent preterm birth.
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