A protocol for a systematic review of clinical practice guidelines for recurrent miscarriage

Abstract

Recurrent miscarriage (RM) was recently re-defined by the European Society of Human Reproduction and Embryology (ESHRE) as the loss of two or more consecutive pregnancies. Before this, and indeed still in some countries, RM was defined as three or more consecutive pregnancy losses. While the incidence of RM depends on the definition employed and population studied, it is generally accepted to affect 1-6% of women of reproductive age. Clinical practice guidelines (CPGs) for RM have been published by some professional organisations. While there are CPGs on miscarriage in Ireland, there are none concerning RM specifically. The aim of this systematic review is to identify, appraise and describe published CPGs for the management, investigation and/or follow-up of RM within high-income countries. Electronic databases (MEDLINE (Ovid®; 1946), Embase® (Elsevier; 1980), CINAHL Complete (EBSCOhost; 1994), Web of Science™ (Thomson Reuters), Scopus (Elsevier; 2004), and Open Grey (INIST-CNRS; 2011)), selected guideline repositories, and the websites of professional societies will be searched to identify CPGs, published within the last 20 years, for potential inclusion. Two reviewers will review abstracts and full texts independently against the eligibility criteria. Characteristics and recommendations of included CPGs will be extracted by one reviewer and double-checked by another. Two reviewers will use the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) instrument independently to assess the quality of the included CPGs. Narrative synthesis will be conducted to appraise and compare CPGs and their recommendations or guidance therein. The identification, appraisal and description of published CPGs in other high-income countries will be a valuable first step in informing efforts to promote the optimisation and standardisation of RM care.

Systematic review of clinical practice guidelines and systematic reviews: A method for conducting comprehensive analysis

“…In addressing a systematic review of Clinical Practice Guidelines (CPGs), it is crucial to clearly structure and focus the research question. To achieve this, the utilization of the PICAR framework is recommended [ 18 , 24 ]. This framework, developed to guide systematic reviews of CPGs for clinical practice, is divided into: P: Population, clinical indications, and conditions; I: Intervention; C: Comparator, comparisons, and key contents; A: Eligible CPG Attributes.…”

A protocol for a systematic review of clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancy

“…The study is based at Cork University Maternity Hospital, Ireland between 2021 and 2022 and will focus on an international review of clinical practice guidelines. In recognition of the tailored approach that a systematic review of clinical practice guidelines requires, and in recognition of the need for a systematic and reproducible method, a methodological guide for conducting systematic reviews of CPGs was followed during the design of this protocol 23 , 24 .…”

Assessing the efficacy and safety of Sildenafil vs. Nifedipine in improving endometrial blood flow and thickness in women with recurrent first-trimester miscarriage

“…In the United States, it is characterized by failed clinical pregnancies in two or more consecutive attempts, with documentation based on histopathology and/or ultrasound [ 1 ]. In the United Kingdom, the criteria specify that three or more early pregnancies are lost consecutively [ 2 ]. The underlying etiology remains unknown in approximately 50% of cases [ 3 ].…”