Abstract
BackgroundThe management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and mortality. Trustworthy evidence-based clinical practice guidelines (CPGs) have a major impact on the positive outcomes of appropriate healthcare. The objective of this study was to critically appraise the quality of recent CPGs for SCD in pregnant women.MethodsClinical questions were identified and the relevant CPG and bibliographic databases were searched and screened for eligible CPGs. Each CPG was appraised by four independent appraisers using the AGREE II Instrument. Inter-rater analysis was conducted.ResultsFour eligible CPGs were appraised: American College of Obstetricians and Gynecologists (ACOG), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Health and Care Excellence (NICE), and Royal College of Obstetricians and Gynaecologists (RCOG). Among them, the overall assessments of three CPGs (NICE, RCOG, NHLBI) scored greater than 70%; these findings were consistent with the high scores in the six domains of AGREE II, including:[1] scope and purpose,[2] stakeholder involvement,[3] rigor of development,[4] clarity of presentation,[5] applicability, and [6] editorial independence domains. Domain [3] scored (90%, 73%, 71%), domain [5] (90%, 46%, 47%), and domain [6] (71%, 77%, 52%) for NICE, RCOG, and NHLBI, respectively. Overall, the clinical recommendations were not significantly different between the included CPGs.ConclusionsThree evidence-based CPGs presented superior methodological quality. NICE demonstrated the highest quality followed by RCOG and NHLBI and all three CPGs were recommended for use in practice.
Highlights
The management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and mortality
Identification of SCD in pregnancy clinical practice guideline or guidance (CPG) The results of the search in the PRISMA statement flow diagram are shown in Fig. 1 [17, 18]
The CPGs were developed by ACOG in January 2007 [22], National Institute of Health and Care Excellence (NICE) in June 2012 [23], Royal College of Obstetricians and Gynaecologists (RCOG) in August 2011 [24], and the US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) in 2014 [25]
Summary
The management of pregnant women with sickle cell disease (SCD) poses a major challenge for maternal healthcare services owing to the potential for complications associated with morbidity and mortality. Sickle cell disease (SCD) is a genetic disorder that causes a vaso-occlusive phenomenon and hemolysis along with a myriad of other major complications that could be lifethreatening. It is one of the commonest inherited diseases, worldwide, and is inherited as an autosomal recessive disease due to the substitution of valine for glutamic acid at the sixth amino acid of the beta-globin chain [1]. The recognized complications include maternal mortality, preeclampsia, eclampsia, venous thromboembolism, cesarean delivery, intrauterine fetal death, and fetal growth restriction [2]
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