Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy.
Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy.
J Perinat Med. 2023 Mar 29;51(8):970-980. doi: 10.1515/jpm-2022-0590. Print 2023 Oct 26.
To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR).
Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR.
Diagnostic criteria of FGR, recommended growth charts, recommendation for detailed anatomical assessment and invasive testing, frequency of fetal growth scans, fetal monitoring, hospital admission, drugs administrations, timing at delivery, induction of labor, postnatal assessment and placental histopathological were assessed. Quality assessment was evaluated by AGREE II tool. Twelve CPGs were included. Twenty-five percent (3/12) of CPS adopted the recently published Delphi consensus, 58.3% (7/12) an estimated fetal weight (EFW)/abdominal circumference (AC) EFW/AC <10th percentile, 8.3% (1/12) an EFW/AC <5th percentile while one CPG defined FGR as an arrest of growth or a shift in its rate measured longitudinally. Fifty percent (6/12) of CPGs recommended the use of customized growth charts to assess fetal growth. Regarding the frequency of Doppler assessment, in case of absent or reversed end-diastolic flow in the umbilical artery 8.3% (1/12) CPGs recommended assessment every 24-48, 16.7% (2/12) every 48-72 h, 1 CPG generically recommended assessment 1-2 times per week, while 25 (3/12) did not specifically report the frequency of assessment. Only 3 CPGs reported recommendation on the type of Induction of Labor to adopt. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 50%.
There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.
系统地识别和批判性评估胎儿生长受限 (FGR) 管理的临床实践指南 (CPG) 的质量。
检索 Medline、Embase、Google Scholar、Scopus 和 ISI Web of Science 数据库，以确定所有关于 FGR 的相关 CPG。
FGR 的诊断标准、推荐的生长图表、详细的解剖评估和侵入性检查建议、胎儿生长扫描、胎儿监测、住院、药物管理、分娩时间、引产、产后评估和胎盘组织病理学的频率进行了评估。使用 AGREE II 工具评估质量评估。纳入 12 项 CPG。25%（3/12）的 CPS 采用了最近发布的 Delphi 共识，58.3%（7/12）采用了估计胎儿体重（EFW）/腹围（AC）EFW/AC <第 10 百分位，8.3%（1/12）采用 EFW/AC <第 5 百分位，而一项 CPG 将 FGR 定义为生长停滞或纵向测量时生长速度的变化。50%（6/12）的 CPG 建议使用定制的生长图表来评估胎儿生长。关于多普勒评估的频率，在脐动脉无舒张末期血流或反向舒张末期血流的情况下，8.3%（1/12）的 CPG 建议每 24-48 小时进行一次评估，16.7%（2/12）每 48-72 小时进行一次评估，1 项 CPG 笼统地建议每周评估 1-2 次，而 25%（3/12）则未具体报告评估频率。只有 3 项 CPG 报告了采用哪种引产方式的建议。首次整体评估 (OA1) 的 AGREE II 标准化领域评分平均为 50%。
发表的 CPG 中，胎儿生长受限管理存在显著异质性。
