Abstract
Overview: The protocol outlines the process designed to systematically review clinical practice guidelines (CPGs), addressing the antenatal management of dichorionic diamniotic (DCDA) twin pregnancies. Background: CPGs are statements that include recommendations intended to optimise patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. CPGs are typically created by scientific institutes, organisations and professional societies, and high-quality CPGs are fundamental to improve patient outcomes, standardise clinical practice and improve the quality of care. While CPGs are designed to improve the quality of care, to achieve this, the identification and appraisal of current international CPGs is required. Because twin pregnancies are identified as high-risk pregnancies, a systematic review of the CPGs in this field is a useful first step for establishing the required high level of care. Aim: The aim of the systematic review is to identify, appraise and examine published CPGs for the antenatal management of DCDA twin pregnancies, within high-income countries. Methods: We will identify published CPGs addressing any aspect of antenatal management of care in DCDA twin pregnancies, appraise the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) the Appraisal of Guidelines Research and Evaluation – Recommendations excellence (AGREE-REX) instruments and examining the recommendations from the identified CPGs. Ultimately, this protocol aspires to clearly define the process for a reproducible systematic review of CPGs within a high-income country, addressing any aspect of antenatal management of DCDA twin pregnancies. PROSPERO registration: CRD42021248586 (24/06/2021)
Highlights
IntroductionTwin pregnancies are fundamentally defined and managed according to their chorionicity (number of outer membranes in a multiple pregnancy) and amnionicity (number of inner membranes that surround babies in a multiple pregnancy)[1]
Twin pregnancies are fundamentally defined and managed according to their chorionicity and amnionicity[1]
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]
Summary
Twin pregnancies are fundamentally defined and managed according to their chorionicity (number of outer membranes in a multiple pregnancy) and amnionicity (number of inner membranes that surround babies in a multiple pregnancy)[1]. Dizygotic twin pregnancies will always be dichorionic diamniotic (DCDA) and have previously been referred to as non-identical twins or fraternal twins. A monozygotic twin pregnancy, referred to as identical twins, can be comprised of dichorionic diamniotic (30%), and monochorionic monoamniotic diamniotic or monochorionic diamniotic (70%); the chorionicity and amnionicity is determined by the time between fertilisation and embryonic cleavage[2]. Monozygotic twins occur in 3.5 per 1000 pregnancies, and this rate remains relatively constant[3]. Rates of dizygotic twins vary according to geographical location, with Nigeria having the highest incidence, 40 of every 1000, and Japan the lowest at 6.7 per 10004
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