Zhang Rongli, Cao Xiao, Feng Haoxue, Liu Ying, Cui Ping, Jiang Hui
Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou 73000, China.
Midwifery. 2023 Jun;121:103659. doi: 10.1016/j.midw.2023.103659. Epub 2023 Mar 22.
Clinical practice guidelines for postpartum hemorrhage (PPH) are available worldwide, but no review has assessed the quality of these guidelines. Poor-quality guidelines for PPH may lead clinicians to follow incorrect approaches.
High-quality guidelines for PPH are important in guiding the clinical diagnosis and treatment of PPH and decreasing maternal mortality. The aim of this study was to assess the quality of clinical guidelines for PPH.
We collected studies from different countries through a literature search including PubMed (MEDLINE), Web of Science, the Cochrane library, websites of health institutions from multiple countries, and search sites, according to the criterion of clinical guidelines for treatment of PPH published between inception and October 2022. Four independent reviewers assessed the eligible guidelines by using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Agreement among reviewers of the guidelines was measured with the intra-class correlation coefficient (ICC). The number of recommendations, strength of recommendations, and level of evidence were determined.
Seven sets of PPH guidelines published from 2007 to 2022 were identified. An overall high agreement among reviewers in each domain was observed (ICC 0.74 to 0.95). The median scores and ranges for each AGREE II domain were as follows: (i) scope and purpose (median = 86.51%, range: 61.11%-94.44%); (ii) stakeholder involvement (median = 73.02%, range: 52.78%-90.28%); (iii) rigor of development (median = 76.49%, range: 66.15%-97.92%); (iv) clarity and presentation (median = 88.49%, range: 68.06%-100.00%); (v) applicability (median = 73.36%, range: 53.13%-93.75%); and (vi) editorial independence (median = 84.52%, range: 60.42%-95.83%). Three sets of PPH guidelines scored high in all domains and were classified as recommended for clinical practice. The other guidelines were classified as recommended with modifications.
The methodological and reporting quality of the guidelines for PPH included in this review was generally good, but the strength of the recommendations and the quality of the evidence varied, thus potentially leading to confusion among clinicians applying the guidelines. An urgent need exists for rigorous studies to close important evidence gaps to support the development of guidelines for PPH.
全球都有产后出血（PPH）的临床实践指南，但尚无综述评估这些指南的质量。质量不佳的PPH指南可能会导致临床医生采用错误的方法。
高质量的PPH指南对于指导PPH的临床诊断和治疗以及降低孕产妇死亡率至关重要。本研究的目的是评估PPH临床指南的质量。
我们通过文献检索从不同国家收集研究，检索范围包括PubMed（MEDLINE）、科学网、Cochrane图书馆、多个国家卫生机构的网站以及搜索网站，检索依据为2022年10月之前发布的PPH治疗临床指南标准。四名独立评审员使用《研究与评价指南评估》（AGREE II）工具对符合条件的指南进行评估。评审员之间对指南的一致性采用组内相关系数（ICC）进行衡量。确定了推荐意见的数量、推荐强度和证据水平。
共识别出2007年至2022年发布的七套PPH指南。各领域评审员之间总体达成高度一致（ICC为0.74至0.95）。AGREE II各领域的中位数得分及范围如下：（i）范围和目的（中位数=86.51%，范围：61.11%-94.44%）；（ii）利益相关者参与度（中位数=73.02%），范围：52.78%-90.28%）；（iii）制定的严谨性（中位数=76.49%，范围：66.15%-97.92%）；（iv）清晰度和呈现方式（中位数=88.49%，范围：68.06%-100.00%）；（v）适用性（中位数=73.36%，范围：53.13%-93.75%）；以及（vi）编辑独立性（中位数=84.52%，范围：60.42%-95.83%）。三套PPH指南在所有领域得分都很高，被归类为推荐用于临床实践。其他指南被归类为经修改后推荐。
本综述纳入的PPH指南的方法学和报告质量总体良好，但推荐强度和证据质量各不相同，因此可能会导致应用这些指南的临床医生感到困惑。迫切需要进行严谨的研究以填补重要的证据空白，以支持PPH指南的制定。
