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D'Alberti E, Rizzo G, Khalil A, Mappa I, Pietrolucci ME, Capannolo G, Alameddine S, Sorrenti S, Zullo F, Giancotti A, Di Mascio D, D'Antonio F. Counseling in fetal medicine: Congenital cytomegalovirus infection. Eur J Obstet Gynecol Reprod Biol 2024; 295:8-17. [PMID: 38310675 DOI: 10.1016/j.ejogrb.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/02/2023] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
Although the clinical work-up of CMV in pregnancy has gradually become more accurate, counseling for CMV is still challenging. Despite the potential feasibility of universal prenatal serological screening, its introduction in prenatal diagnosis continues to raise concerns related to its real cost-effectiveness. Contextually, anticipating the confirmation of fetal infection earlier in pregnancy is one of the most pressing issues to reduce the parental psychological burden. Amniocentesis is still the gold standard and recent data have demonstrated that it could be performed before 20 weeks of gestation, provided that at least 8 weeks have elapsed from the presumed date of maternal seroconversion. New approaches, such as chorionic villus sampling (CVS) and virome DNA, even if not yet validated as confirmation of fetal infection, have been studied alternatively to amniocentesis to reduce the time-interval from maternal seroconversion and the amniocentesis results. Risk stratification for sensorineural hearing loss (SNHL) and long-term sequelae should be provided according to the prognostic predictors. Nevertheless, in the era of valacyclovir, maternal high-dose therapy, mainly for first trimester infections, can reduce the risk of vertical transmission and increase the likelihood of asymptomatic newborns, but it is still unclear whether valacyclovir continues to exert a beneficial effect on fetuses with positive amniocentesis. This review provides updated evidence-based key counseling points with GRADE recommendations.
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Affiliation(s)
- Elena D'Alberti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, Rome, Italy
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, the United Kingdom of Great Britain and Northern Ireland; Fetal Medicine Unit, St George's Hospital, London, the United Kingdom of Great Britain and Northern Ireland; Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, the United Kingdom of Great Britain and Northern Ireland
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine Ospedale Cristo Re, University of Roma Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, Rome, Italy
| | - Giulia Capannolo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Alameddine
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Sorrenti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Fabrizio Zullo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy.
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
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De Vito M, Cetraro J, Capannolo G, Alameddine S, Patelli C, D'Antonio F, Rizzo G. Cervical length as a screening tool for preterm birth in twin pregnancies: a systematic review and critical evaluation of quality clinical practice guidelines. J Perinat Med 2024; 52:262-269. [PMID: 38105222 DOI: 10.1515/jpm-2023-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Twin pregnancies are at increased risk of preterm birth (PTB) compared to singletons. Evaluation of cervical length (CL) represents the optimal tool to screen PTB in singleton. Conversely, there is less evidence on the use of CL in twins. Our aim was to evaluate the methodological quality and clinical heterogeneity of clinical practice guidelines (CPGs) on the CL application in twins using AGREE II methodology. METHODS MEDLINE, Scopus, and websites of the main scientific societies were examined. The following aspects were evaluated: diagnostic accuracy of CL, optimal gestational age at assessment and interventions in twin pregnancies with reduced CL. The quality of the published CPGs was carried out using "The Appraisal of Guidelines for REsearch and Evaluation (AGREE II)" tool. The quality of guideline was rated using a scoring system. Each considered item was evaluated by the reviewers on a seven-point scale that ranges from 1 (strongly disagree) to 7 (strongly agree). A cut-off >60 % identifies a CPGs as recommended. RESULTS The AGREE II standardized domain scores for the first overall assessment had a mean of 74 %. The score was more than 60 % in the 66.6 % of CPGs analyzed indicating an agreement between the reviewers on recommending the use of these CPGs. A significant heterogeneity was found; there was no specific recommendation on CL assessment in about half of the published CPGs. There was also significant heterogeneity on the CL cut-off to prompt intervention. CONCLUSIONS Despite the fact that the AGREE II analysis showed that the majority of the included guidelines are of good quality, there was a significant heterogeneity among CPGs as regard as the indication, timing, and cut-off of CL in twins as well as in the indication of interventions.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Jessica Cetraro
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Chiara Patelli
- Department of Obstetrics and Gynecology, Università di Verona, Verona, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
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Alameddine S, Capannolo G, Rizzo G, Khalil A, Di Girolamo R, Iacovella C, Liberati M, Patrizi L, Acharya G, Odibo AO, D'Antonio F. A systematic review and critical evaluation of quality of clinical practice guidelines on fetal growth restriction. J Perinat Med 2023; 51:970-980. [PMID: 36976902 DOI: 10.1515/jpm-2022-0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/08/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR). CONTENT Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR. SUMMARY 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%. OUTLOOK There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.
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Affiliation(s)
- Sara Alameddine
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giulia Capannolo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Raffaella Di Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
| | | | - Marco Liberati
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Lodovico Patrizi
- Department of Obstetrics and Gynaecology Fondazione Policlinico Tor Vergata Università Roma Tor Vergata, Roma, Italy
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesco D'Antonio
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Capannolo G, D'Amico A, Alameddine S, Di Girolamo R, Khalil A, Calì G, Trish IT, Coutinho CM, Herrera M, Liberati M, Lucidi A, Palacios-Jaraquemada J, Buca D, D'Antonio F. Placenta accreta spectrum disorders clinical practice guidelines: A systematic review. J Obstet Gynaecol Res 2023; 49:1313-1321. [PMID: 36796351 DOI: 10.1111/jog.15544] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/28/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To objectively assess the quality of the published clinical practice guidelines (CPGs) on the management of pregnancies complicated by placenta accreta spectrum (PAS)disorders. METHODS MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to the management of pregnancies with suspected PAS disorders were evaluated: risk factors for PAS, prenatal diagnosis, role of interventional radiology and ureteral stenting, and optimal surgical management. The assessment of risk of bias and quality assessment of the CPGs were performed using the (AGREE II) tool (Brouwers et al., 2010). To define a CPG as of good quality we adopted a cut-off score >60%. RESULTS Nine CPGs were included. Specific risk factors for referral were assessed by 44.4% (4/9) of CPGs, mainly consisting in the presence of placenta previa and a prior cesarean delivery or uterine surgery. About 55.6% of CPGs (5/9) suggested ultrasound assessment of women with risk factors for PAS in the second and third trimester of pregnancy and 33.3% (3/9) recommended magnetic resonance imaging (MRI); 88.9% (8/9) of CPGs recommended cesarean delivery at 34-37 weeks of gestation. There was not generally consensus on the use of interventional radiology and ureteral stenting before surgery for PAS. Finally, hysterectomy was the recommend surgical approach by 77.8% (7/9) of the included CPGs. CONCLUSION Most of the published CPGs on PAS are generally of good quality. There was general agreement among the different CPGs on PAS as a regard as risk stratification, timing at diagnosis and delivery but not on the indication for MRI, use of interventional radiology and ureteral stenting.
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Affiliation(s)
- Giulia Capannolo
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alice D'Amico
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Sara Alameddine
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, Federico II, University of Naples, Naples, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Giuseppe Calì
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - Ilan T Trish
- Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Health, New York, New York, USA
| | - Conrado M Coutinho
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo: Ribeirão Preto, São Paulo, Brazil
| | - Mauricio Herrera
- Maternal fetal medicine, Obstetric Department, Clinica Colsanitas Bogotà, Bogota, Colombia
| | - Marco Liberati
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alessandro Lucidi
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | | | - Danilo Buca
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Mappa I, D'Antonio F, Khalil A, De Vito M, Alameddine S, Capannolo G, di Mascio D, Rizzo G. Prognostic value of amniotic fluid viral load to predict adverse outcome in pregnancies complicated by congenital Cytomegalovirus infection: a multicenter study. Fetal Diagn Ther 2023; 50:1-7. [PMID: 36623501 DOI: 10.1159/000528936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION To report the prognostic value of Cytomegalovirus (CMV) viral load in the amniotic fluid (AF) in predicting the outcome of infected pregnancies. METHODS Multicenter retrospective study involving 11 Italian referral centers from 2012 to 2021. Inclusion criteria were fetuses with confirmed congenital CMV infection. The primary outcome was the prognostic value accuracy of CMV qPCR in AF in predicting the risk of additional anomalies detected either at follow-up ultrasound or fetal MRI. The secondary outcome was prediction of post-natal clinical symptoms related CMV infection. Multivariate logistic regression and area under the curve (AUC) analyses were used to analyze the data. RESULTS 104 fetuses were included. Associated anomalies detected at follow-up ultrasound or fetal MRI were detected in 14.4% of cases (15/104). Mean AF CMV viral load was significantly higher in fetuses with compared to those without additional anomalies at follow-up ultrasound or fetal MRI (3346634.27±402582.95 vs 761934±222513,2 p<0.001). At multivariate logistic regression analysis, CMV AF viral load was independently associated with the presence of additional anomalies at follow up ultrasound or MRI, with an OR of 1.07 (p= 0.010), while maternal age(p=0.24), trimester at maternal infection (p= 0.97), type of infection (primary vs non-primary) (p=0.12) were not. CMV AF viral load had AUC of 0.755 for the occurrence of anomalies due to CMV infection, with an optimal cut-off point of >1310520 copies/ml, a sensitivity of 66.7% and a specificity of 84.3% a positive likelihood ratio of 4.24. Once excluding fetuses with anomalies at ultrasound or MRI, the diagnostic performance of qPCR in identifying fetuses with symptomatic infection after birth was low, with an AUC of 0.586, Conclusion: CMV viral load at second trimester amniocentesis has a moderate accuracy for the occurrence of CMV related anomalies in fetuses with congenital infection and normal ultrasound at the initial diagnosis. Conversely, prediction of symptomatic infection is low. .
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma Italy, Università di Roma Tor Vergata, Rome, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Marika De Vito
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma Italy, Università di Roma Tor Vergata, Rome, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Daniele di Mascio
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma Italy, Università di Roma Tor Vergata, Rome, Italy
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De Vito M, Alameddine S, Capannolo G, Mappa I, Gualtieri P, Di Renzo L, De Lorenzo A, D’ Antonio F, Rizzo G. Systematic Review and Critical Evaluation of Quality of Clinical Practice Guidelines on Nutrition in Pregnancy. Healthcare (Basel) 2022; 10:healthcare10122490. [PMID: 36554014 PMCID: PMC9778102 DOI: 10.3390/healthcare10122490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Objective: To report the quality and clinical heterogeneity of the published clinical practice guidelines (CPGs) on nutrition in pregnancy. Methods: MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to nutrition in pregnancy were addressed: specific requirements during pregnancy, description of a balanced diet, weight gain, prevention of food-borne, nutrition in peculiar sub-groups of women, and maternal or perinatal outcomes. The assessment of the risk of bias and quality assessment of the included CPGs were performed using “The Appraisal of Guidelines for REsearch and Evaluation (AGREE II)” tool divided in six quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence. Mean ± standard deviation (SD) was used to summarize the scores across all the guidelines per domain. The quality of each guideline was computed using the scoring system proposed by Amer et al. A cut-off of >60% was sued to define a CGP as recommended. Results: Eighteen CPGs were included. There was a substantial heterogeneity in the recommended dose for vitamins, folic acid, and micronutrient intake during pregnancy among the different published CPGs. 27.8% (5/18) of the CPGs recommended a daily intake of folic acid of 200 mcg, 38.8% (7/18) 400 mcg, 16.7% (3/18) 600 mcg while the remaining CPGs suggested dose between 400 and 600−800 mc per day. Adequate maternal hydration was advocated in the large majority of included CPGs, but a specific amount of water intake was not reported in 83.3% (15/18) cases. There was also significant heterogeneity in various other aspects of nutrition recommendation among the different CPGs, including gestational weight gain (55.5%), prevention of food-borne diseases in pregnancy (72.2%), nutrition in particular groups of pregnant women (83.3%), maternal and perinatal outcomes (72.2%). The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 65% but only half scored more than 60%. Conclusion: The published CPGs on nutrition in pregnancy show an overall good methodology, but also a substantial heterogeneity as regard as different major aspects on nutrition in pregnancy.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy
| | - Paola Gualtieri
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata Section of Clinical Nutrition and Nutrigenomic, 00185 Roma, Italy
| | - Laura Di Renzo
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata Section of Clinical Nutrition and Nutrigenomic, 00185 Roma, Italy
| | - Antonino De Lorenzo
- Department of Biomedicine and Prevention, Università di Roma Tor Vergata Section of Clinical Nutrition and Nutrigenomic, 00185 Roma, Italy
| | - Francesco D’ Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy
- Correspondence:
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Di Girolamo R, Khalil A, Rizzo G, Capannolo G, Buca D, Liberati M, Acharya G, Odibo AO, D'Antonio F. Erratum to systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. Am J Obstet Gynecol MFM 2022; 4:100683. [PMID: 35941065 PMCID: PMC9355748 DOI: 10.1016/j.ajogmf.2022.100683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Raffaella Di Girolamo
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St. George's Hospital, London, United Kingdom (Dr Khalil)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, Rome, Italy (Dr Rizzo)
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Danilo Buca
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Marco Liberati
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio)
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden (Dr Acharya); Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway (Dr Acharya); Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway (Dr Acharya)
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Dr Odibo)
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy (Drs Di Girolamo, Capannolo, Buca, Liberati, and D'Antonio).
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Di Girolamo R, Khalil A, Rizzo G, Capannolo G, Buca D, Liberati M, Acharya G, Odibo AO, D'Antonio F. Systematic review and critical evaluation of quality of clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. Am J Obstet Gynecol MFM 2022; 4:100654. [PMID: 35504493 PMCID: PMC9057927 DOI: 10.1016/j.ajogmf.2022.100654] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically identify and critically assess the quality of clinical practice guidelines for the management of SARS-CoV-2 infection in pregnancy. DATA SOURCES Medline, Scopus, and ISI Web of Science databases were searched until February 15, 2022. STUDY ELIGIBILITY CRITERIA Inclusion criteria were clinical practice guidelines on the management of SARS-CoV-2 infection in pregnancy. The risk of bias and quality assessments of the included clinical practice guidelines were performed using the Appraisal of Guidelines for REsearch and Evaluation II tool, which is considered the gold standard for quality assessment of clinical practice guidelines. To define a clinical practice guideline as of good quality, we adopted the cutoff score proposed by Amer et al: if the overall clinical practice guideline score was >60%, it was recommended. METHODS The following clinical points related to the management of pregnant women with SARS-CoV-2 infection were addressed: criteria for maternal hospitalization, recommendations for follow-up fetal growth scan, specific recommendations against invasive procedures, management of labor, timing of delivery, postpartum care, and vaccination strategy. RESULTS A total of 28 clinical practice guidelines were included. All recommended hospitalization only for severe disease; 46.1% (6/13) suggested a fetal growth scan after SARS-CoV-2 infection, whereas 23.1% (3/13) did not support this practice. Thromboprophylaxis with low-molecular-weight heparin was recommended in symptomatic women by 77.1% (7/9) of the clinical practice guidelines. None of the guidelines recommended administering corticosteroids only for the presence of SARS-CoV-2 infection in preterm gestation, unless specific obstetrical indication exists. Elective induction of labor from 39 weeks of gestation was suggested by 18.1% (2/11) of the clinical practice guidelines included in the present review, whereas 45.4% (5/11) did not recommend elective induction unless other obstetrical indications coexisted. There were 27% (3/11) of clinical practice guidelines that suggested shortening of the second stage of labor, and active pushing was supported by 18.1% (2/11). There was general agreement among the clinical practice guidelines in not recommending cesarean delivery only for the presence of maternal infection and in recommending vaccine boosters at least 6 months after the primary series of vaccination. The Appraisal of Guidelines for REsearch and Evaluation II standardized domain scores for the first overall assessment of clinical practice guidelines had a mean of 50% (standard deviation±21.82%), and 9 clinical practice guidelines scored >60%. CONCLUSION A significant heterogeneity was found in some of the main aspects of the management of SARS-CoV-2 infection in pregnancy, as reported by the published clinical practice guidelines.
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Affiliation(s)
- Raffaella Di Girolamo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, United Kingdom (Prof. Khalil)
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Università degli studi di Roma Tor Vergata, Roma, Italy (Prof. Rizzo)
| | - Giulia Capannolo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Danilo Buca
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Marco Liberati
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio)
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden (Prof. Acharya); Women's Health and Perinatology Research Group, Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway (Prof. Acharya); Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway (Prof. Acharya)
| | - Anthony O Odibo
- Divisions of Maternal-Fetal Medicine and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (Prof. Odibo)
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy (Dr. Di Girolamo, Dr. Capannolo, Dr. Buca, Prof. Liberati, and Prof. D'Antonio).
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De Vito M, Capannolo G, Alameddine S, Fiorito R, Lena A, Patrizi L, D' Antonio F, Rizzo G. Trauma in pregnancy clinical practice guidelines: systematic review. J Matern Fetal Neonatal Med 2022; 35:9948-9955. [PMID: 35703623 DOI: 10.1080/14767058.2022.2078190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To objectively evaluate the methodological quality and clinical heterogeneity robustness of the published clinical practice guidelines (CPGs) on the management of trauma in pregnancy. MATERIALS AND METHODS Pubmed, Google Scholar, UpToDate, and Scopus Database were searched. The risk of bias and quality assessment of the included CPGs were performed using "The Appraisal Of Guidelines for Research and Evaluation (AGREE II)" tool. The following points relating to the management of trauma during pregnancy were addressed: quality of evidence assessment, classification of recommendations, main causes of trauma in pregnancy, importance of correct use of seat belts, ultrasound scans and/or pregnancy test in every female of reproductive age, description of physiological changes in pregnancy, classification in primary and secondary survey, primary survey based on ABCD Approach, fetus viable based on the weeks, radiographic studies for maternal evaluation, duration of fetal monitoring, use of anti-D immunoglobulin in rhesus-D-negative pregnant trauma patients, description of dose of RhD-Ig, the way to define gestational age if it was undetermined, descriptions of obstetrical complications, use of tetanus vaccination, and timing to perimortem cesarean section (CS). RESULTS Six CPGs were included. Quality of evidence assessment was described in 16.7% of CPGs (1/6), while it was not reported in 83.3% (5/6). Classification of recommendations was reported in 50% (3/3) of the CPGs. Motor vehicle crash was reported as the main cause of trauma in pregnancy in all the CPGs included in the present review, despite that the importance of a correct use of seat belts was described only in the 50% (3/6). Definition of fetal viability was also different among the included CPGs; in 50% (3/6) defined a fetus viable when it from 23 weeks, 33.3% (2/6) from 24 weeks, and 16.7% (1/6) from 20 weeks of gestation. Regarding the type of fetal monitoring, 33.3% (2/6) CPGs recommended CTG assessment at least every 4 h, 16.7% (1/6) at least every 6 h, 33.3% for 24 h if there are not reassuring signs and 16.7% (1/6) did not specify the duration of monitoring. Recommendations about the use of anti-D-immunoglobulin in rhesus-D-negative pregnant were also heterogeneous: 50% (3/6) of the CPGs suggested administration in all rhesus-D-negative pregnant women, 16.7% (1/6) only according to gestational age at trauma or in case of significant abdominal trauma, and 16.7% (1/6) only in case of positive Kleihauer test while 16.7% (1/6) did not specify it. Administration of tetanus vaccination was suggested in in 33.3% (2/6) of CPGs. Finally, there were different descriptions of timing to perimortem CS: 33.3% (2/6) of CPGs claims to do CS no later than 4 min, 50% (3/6) no later than 5 min, and 16.7% (1/6) does not describe timing for CS. The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 69%. Only three CPGs scored more than 60% and revealed a consensus agreement between the reviewers on recommending the use of these CPGs. CONCLUSION There is clinical heterogeneity in some of the most relevant aspects of the management of pregnant women with trauma. The findings from this systematic review highlight the need for up to date and shared guidelines promoted by the main body societies in order make management of pregnant women with trauma homogenous.
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Affiliation(s)
- Marika De Vito
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Giulia Capannolo
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Sara Alameddine
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Roberto Fiorito
- Department of Surgery Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Alessandro Lena
- Department of Obstetrics and Gynecology Ospedale San Paolo Civitavecchia, Roma, Italy
| | - Lodovico Patrizi
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Francesco D' Antonio
- Department of Obstetrics and Gynecology Chieti, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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