428 A systematic review of clinical practice guidelines for recurrent miscarriage in High-income countries

Abstract

Recurrent miscarriage (RM) affects 1-2% of women of reproductive age, depending on the definition used. Evidence-based, up-to-date guidelines are required to inform care decisions. An examination of published clinical practice guidelines (CPGs) for RM in high-income countries help identify the degree of consensus in CPG recommendations and aid efforts to optimise and standardise care. This study identifies, appraises and describes CPGs, published since 2000, for the management, investigation and/or follow-up of RM within high-income countries. A systematic review was conducted. Six bibliographic databases, eight guideline repositories, and the websites of eleven professional organizations were searched. Two reviewers screened abstracts and full texts independently against the eligibility criteria. One reviewer extracted the characteristics and recommendations of included CPGs, and another double-checked these. The quality of eligible CPGs was assessed independently by three appraisers, using the Appraisal of Guidelines for Research and Evaluation (AGREE II). A narrative synthesis was conducted to appraise and compare CPGs and their recommendations. 4,108 records were screened, 170 full-texts assessed, and 32 CPGs included in the final synthesis. From these, 373 recommendations concerning first trimester RM were identified, across four sub-categories: structure of care (42 recommendations, 9 CPGs), investigations (139 recommendations, 24 CPGs), treatment (151 recommendations, 23 CPGs), and counselling/supportive care (43 recommendations, 8 CPGs). The quality of included CPGs varied; 30 were recommended for use with modification; one was not recommended. Most scored ‘poor’ on applicability (84%) and editorial independence (69%). There were varying levels of consensus across the included CPGs, with some conflicting recommendations. There is a need to build the evidence base for RM, and to improve both the quality of evidence underpinning CPGs and the rigour of their development, including efforts to incorporate a multi-disciplinary approach with patient involvement.