Abstract：
BACKGROUND: To systematically identify and critically assess the quality of clinical practice guidelines (CPGs) on management fetal growth restriction (FGR).
BACKGROUND: Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR.
CONCLUSIONS: 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%.
CONCLUSIONS: There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.
BACKGROUND: Medline, Embase, Google Scholar, Scopus and ISI Web of Science databases were searched to identify all relevant CPGs on FGR.
CONCLUSIONS: 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%.
CONCLUSIONS: There is significant heterogeneity in the management of pregnancies complicated by FGR in published CPGs.
摘要：
背景：旨在系统地确定并严格评估有关胎儿生长受限（FGR）的临床实践指南（CPG）的质量。
背景：Medline，Embase,谷歌学者，搜索Scopus和ISIWebofScience数据库以识别FGR上的所有相关CPG。
结论：FGR的诊断标准，推荐的增长图表，详细的解剖评估和侵入性测试的建议，胎儿生长扫描的频率,胎儿监护,入院,药物管理部门，交货时间，引产,评估了产后评估和胎盘组织病理学.质量评估通过AGREEII工具进行评估。包括12个CPG。25%(3/12)的CPS采用了最近公布的德尔菲共识，58.3％（7/12），估计胎儿体重（EFW）/腹围（AC）EFW/AC<10百分位数，8.3%(1/12)的EFW/AC<第5百分位数,而一个CPG将FGR定义为纵向测量的生长停滞或其速率变化。百分之五十（6/12）的CPG建议使用定制的生长图来评估胎儿的生长。关于多普勒评估的频率，在缺乏或逆转的情况下，脐动脉舒张末期血流8.3%（1/12）CPGs建议每24-48，16.7%（2/12）每48-72小时，1个CPG一般推荐的评估，每周1-2次，而25（3/12）没有具体报告评估频率。只有3个CPG报告了关于采用的引产类型的建议。第一次总体评估（OA1）的AGREEII标准化领域得分的平均值为50％。
结论：在已发表的CPGs中，FGR并发妊娠的管理存在显著的异质性。
背景：Medline，Embase,谷歌学者，搜索Scopus和ISIWebofScience数据库以识别FGR上的所有相关CPG。
结论：FGR的诊断标准，推荐的增长图表，详细的解剖评估和侵入性测试的建议，胎儿生长扫描的频率,胎儿监护,入院,药物管理部门，交货时间，引产,评估了产后评估和胎盘组织病理学.质量评估通过AGREEII工具进行评估。包括12个CPG。25%(3/12)的CPS采用了最近公布的德尔菲共识，58.3％（7/12），估计胎儿体重（EFW）/腹围（AC）EFW/AC<10百分位数，8.3%(1/12)的EFW/AC<第5百分位数,而一个CPG将FGR定义为纵向测量的生长停滞或其速率变化。百分之五十（6/12）的CPG建议使用定制的生长图来评估胎儿的生长。关于多普勒评估的频率，在缺乏或逆转的情况下，脐动脉舒张末期血流8.3%（1/12）CPGs建议每24-48，16.7%（2/12）每48-72小时，1个CPG一般推荐的评估，每周1-2次，而25（3/12）没有具体报告评估频率。只有3个CPG报告了关于采用的引产类型的建议。第一次总体评估（OA1）的AGREEII标准化领域得分的平均值为50％。
结论：在已发表的CPGs中，FGR并发妊娠的管理存在显著的异质性。
