Clinical guidelines for prevention and management of preterm birth: a systematic review

Background Clinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB). Objectives To summarise CPG recommendations for PTB and identify areas of international consensus. Search strategy In June 2017 we searched for all CPG relavant to PTB without language restrictions. Selection criteria CPG were eligible if the following criteria were met. i.The guideline was published or current from June 2013. ii.The guideline recommended practices for the prevention or management of PTB relevant to our pre-specified clinical questions for screening, medications or surgery and other interventions. iii.Publications on methods of guideline development for eligible CPG were included to enable quality assessment. Data collection and Analysis Two authors classified CPG recommendations relevant to pre-specified clinical questions. When more than 70% of CPGs reporting on a topic recommended or rejected an intervention we regarded this as consensus. We summarised recommendations in tables. Main results We identified 49 guidelines from 16 guideline developers. We found consensus for several clinical practices including cervical length screening for high risk women; short-term tocolysis; steroids for fetal lung maturation; and magnesium sulphate for fetal neuroprotection. We found discrepant recommendations for progesterone and fibronectin. No guideline identified an effective strategy for women with multiple pregnancy. Conclusions We identified interventions for which there is an international consensus of benefit for PTB. Systematic reviews of CPG using standardized methodology will help avoid duplication and target scarce resources for guideline developers globally. This article is protected by copyright. All rights reserved.