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Abstract：
BACKGROUND: There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction of labour and ascertain whether inconsistencies can be explained by variability guideline quality.
METHODS: We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument.
RESULTS: Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed ≥37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy.
CONCLUSIONS: Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
METHODS: We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument.
RESULTS: Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed ≥37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy.
CONCLUSIONS: Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
摘要：
背景：医院之间的引产率存在广泛且无法解释的差异。一些实践差异可能源于临床指南的变异性。这项审查旨在确定引产指南在多大程度上提供了一致的建议，和时间，引产，并确定不一致是否可以用变异性指南质量来解释。
方法：我们对2008年至2018年间发布的国家和国际英语指南进行了系统搜索。搜索了一般的引产指南和包含引产建议的特定条件指南。指南由两名审查者独立审查和提取。使用《研究和评估指南II》工具评估指南质量。
结果：纳入了49个不同质量的指南。指南建议基本一致的适应症包括延长妊娠（41至42周之间的诱导），早产胎膜早破,和足月子痫前期（当子痫前期诊断≥37周时诱导）。指南也一致认为胎动减少和羊水过少是引产的有效指征。尽管时间建议不存在或不一致。在有效性和/或诱导时间上几乎没有共识的常见适应症包括妊娠期糖尿病，胎儿巨大儿,孕妇体重指数升高，双胞胎怀孕。
结论：关于诱导适应症的临床实践指南存在很大差异。由于评级类似质量的指南提出了相互矛盾的建议，指南变异性不能用指南质量来解释.指南的可变性可能部分解释了引产率的无法解释的变化。
方法：我们对2008年至2018年间发布的国家和国际英语指南进行了系统搜索。搜索了一般的引产指南和包含引产建议的特定条件指南。指南由两名审查者独立审查和提取。使用《研究和评估指南II》工具评估指南质量。
结果：纳入了49个不同质量的指南。指南建议基本一致的适应症包括延长妊娠（41至42周之间的诱导），早产胎膜早破,和足月子痫前期（当子痫前期诊断≥37周时诱导）。指南也一致认为胎动减少和羊水过少是引产的有效指征。尽管时间建议不存在或不一致。在有效性和/或诱导时间上几乎没有共识的常见适应症包括妊娠期糖尿病，胎儿巨大儿,孕妇体重指数升高，双胞胎怀孕。
结论：关于诱导适应症的临床实践指南存在很大差异。由于评级类似质量的指南提出了相互矛盾的建议，指南变异性不能用指南质量来解释.指南的可变性可能部分解释了引产率的无法解释的变化。
