Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：与单胎相比，双胎妊娠早产（PTB）的风险增加。宫颈长度（CL）的评估代表了筛选单例PTB的最佳工具。相反，在双胞胎中使用CL的证据较少。我们的目的是使用AGREEII方法评估双胞胎中CL应用的临床实践指南（CPG）的方法学质量和临床异质性。
方法：MEDLINE，Scopus,并审查了主要科学学会的网站。对以下方面进行了评估：CL的诊断准确性，CL降低的双胎妊娠评估和干预措施时的最佳胎龄。已发布的CPG的质量是使用“重新搜索和评估指南评估（AGREEII）”工具进行的。使用评分系统对指南的质量进行评级。审稿人以7分制对每个考虑的项目进行评估，范围从1（强烈不同意）到7（强烈同意）。>60%的截止值将CPG识别为推荐的。
结果：第一次总体评估的AGREEII标准化领域得分的平均值为74%。在分析的66.6％的CPG中，得分超过60％，这表明审阅者之间就推荐使用这些CPG达成了协议。发现了显着的异质性；在大约一半的已发表的CPG中，没有关于CL评估的具体建议。CL截止值也存在显著异质性以提示干预。
结论：尽管AGREEII分析表明所纳入的大多数指南质量良好，作为适应症，CPG之间存在显著的异质性，定时,以及双胞胎中CL的截止以及干预措施的指示。
方法：MEDLINE，Scopus,并审查了主要科学学会的网站。对以下方面进行了评估：CL的诊断准确性，CL降低的双胎妊娠评估和干预措施时的最佳胎龄。已发布的CPG的质量是使用“重新搜索和评估指南评估（AGREEII）”工具进行的。使用评分系统对指南的质量进行评级。审稿人以7分制对每个考虑的项目进行评估，范围从1（强烈不同意）到7（强烈同意）。>60%的截止值将CPG识别为推荐的。
结果：第一次总体评估的AGREEII标准化领域得分的平均值为74%。在分析的66.6％的CPG中，得分超过60％，这表明审阅者之间就推荐使用这些CPG达成了协议。发现了显着的异质性；在大约一半的已发表的CPG中，没有关于CL评估的具体建议。CL截止值也存在显著异质性以提示干预。
结论：尽管AGREEII分析表明所纳入的大多数指南质量良好，作为适应症，CPG之间存在显著的异质性，定时,以及双胞胎中CL的截止以及干预措施的指示。
