目标:根据2017年至2022年文献中的最佳可用证据,对复发性妊娠丢失(RPL)妇女的建议管理有哪些更新?
结论:指南开发小组(GDG)更新了11项关于RPL调查和治疗的现有建议,以及护理应该如何组织,并增加了一项关于RPL女性子宫腺肌病调查的新建议。
背景:关于RPL的先前ESHRE指南于2017年发布,需要更新。
UNASSIGNED:该指南是根据ESHRE指南的开发和更新的结构化方法开发和更新的。文献搜索已更新,并对相关新证据进行评估.包括2017年3月31日至2022年2月28日发表的以英语撰写的相关论文。累计活产率,活产率,妊娠丢失率(或流产率)被认为是关键结局.
方法:根据收集的证据,我们对建议进行了更新和讨论,直至在GDG内达成共识.在最新草案定稿后,组织了一次利益攸关方审查。最终版本由GDG和ESHRE执行委员会批准。
结果:新版本的指南提供了39条关于风险因素的建议,预防,以及对RPL夫妇的调查,关于治疗的38条建议。其中包括62项基于证据的建议,其中33项作为强有力的建议,29项作为有条件的建议,以及15项良好做法要点。在基于证据的建议中,12(19.4%)得到中等质量证据的支持。其余的建议得到较低的支持(34项建议;54.8%),或非常低质量的证据(16条建议;25.8%)。由于RPL护理缺乏循证调查和治疗,该指南还明确提到了那些不应用于RPL夫妇的研究和治疗.
结论:指南已经更新;但是,目前为RPL夫妇提供的一些调查和治疗方法尚未得到很好的研究;对于大多数这些调查和治疗,根据证据不足,提出了不使用干预措施或治疗的建议.未来的研究可能需要对这些建议进行修订。
结论:该指南为临床医生提供了关于RPL最佳实践的明确建议,基于现有的最佳和最新证据。此外,提供了一系列研究建议,以刺激RPL的进一步研究。尽管如此,缺乏RPL的统一定义是该领域有限的科学证据的最关键后果之一。
背景:该指南由ESHRE制定和资助,支付与指南会议相关的费用,随着文献检索和指南的传播。准则小组成员没有收到付款。O.B.C.报告是欧洲生殖免疫学会执行委员会的成员,并因在2020年在澳大利亚举办有关RPL的讲座而获得酬金。M.G.报告生殖医学中心收到的无条件研究和教育补助金,来自Guerbet的阿姆斯特丹UMC,默克公司和Ferring,与提交的工作无关。S.L.报告EXAMENLAB有限公司的职位资金和EXAMENLAB有限公司(首席执行官)的股票或合伙企业的所有权权益。S.Q.报告说,他是汤米国家流产研究中心的副主任,该机构收到的研究费用,员工时间,和研究用消耗品。H.S.N.报告了FreyaBiosciencesApS向机构支付的赠款,Ferring制药,生物创新研究所,丹麦教育部,诺沃北欧基金会,奥古斯丁·丰登,OdaOgHansSvenningsensFond,DemantFonden,OleKirksFond,和独立研究基金丹麦和演讲者费林制药公司的讲座费用,默克A/S,AstraZeneca,IBSA北欧和库克医疗。她还报告说,她是一位无薪创始人,也是一个生育基金会的主席。M.-L.v.d.H.获得了关于RPL护理讲座的小额酬金。其他作者没有利益冲突要声明。
结论:本指南代表了ESHRE的观点,这是在仔细考虑准备时可用的科学证据后获得的。在某些方面缺乏科学证据的情况下,有关ESHRE利益相关者之间已达成共识。遵守这些临床实践指南并不能保证成功或特定的结果。它也没有建立护理标准。临床实践指南并不取代将临床判断应用于每个个体陈述的需要,也不是基于地点和设施类型的变化。ESHRE不做任何担保,明示或暗示,关于临床实践指南,并特别排除对特定用途或目的的适销性和适用性的任何保证。(完整的免责声明可在www。eshre.欧盟/准则。).
OBJECTIVE: What are the updates for the recommended management of women with recurrent pregnancy loss (RPL) based on the best available evidence in the literature from 2017 to 2022?
CONCLUSIONS: The guideline development group (GDG) updated 11 existing recommendations on investigations and treatments for RPL, and how care should be organized, and added one new recommendation on adenomyosis investigation in women with RPL.
BACKGROUND: A previous ESHRE guideline on RPL was published in 2017 and needs to be updated.
UNASSIGNED: The guideline was developed and updated according to the structured methodology for development and update of ESHRE
guidelines. The literature searches were updated, and assessments of relevant new evidence were performed. Relevant papers published between 31 March 2017 and 28 February 2022 and written in English were included. Cumulative live birth rate, live birth rate, and pregnancy loss rate (or miscarriage rate) were considered the critical outcomes.
METHODS: Based on the collected evidence, recommendations were updated and discussed until
consensus was reached within the GDG. A stakeholder review was organized after the updated draft was finalized. The final version was approved by the GDG and the ESHRE Executive Committee.
RESULTS: The new version of the guideline provides 39 recommendations on risk factors, prevention, and investigation in couples with RPL, and 38 recommendations on treatments. These includes 62 evidence-based recommendations-of which 33 were formulated as strong recommendations and 29 as conditional-and 15 good practice points. Of the evidence-based recommendations, 12 (19.4%) were supported by moderate-quality evidence. The remaining recommendations were supported by low (34 recommendations; 54.8%), or very low-quality evidence (16 recommendations; 25.8%). Owing to the lack of evidence-based investigations and treatments in RPL care, the guideline also clearly mentions those investigations and treatments that should not be used for couples with RPL.
CONCLUSIONS: The guidelines have been updated; however, several investigations and treatments currently offered to couples with RPL have not been well studied; for most of these investigations and treatments, a recommendation against using the intervention or treatment was formulated based on insufficient evidence. Future studies may require these recommendations to be revised.
CONCLUSIONS: The guideline provides clinicians with clear advice on best practice in RPL, based on the best and most recent evidence available. In addition, a list of research recommendations is provided to stimulate further studies in RPL. Still, the absence of a unified definition of RPL is one of the most critical consequences of the limited scientific evidence in the field.
BACKGROUND: The guideline was developed and funded by ESHRE, covering expenses associated with the
guideline meetings, with the literature searches and with the dissemination of the
guideline. The guideline group members did not receive payment.O.B.C. reports being a member of the executive board of the European Society for Reproductive Immunology and has received payment for honoraria for giving lectures about RPL in Australia in 2020. M.G. reports unconditional research and educational grant received by the Centre for Reproductive Medicine, Amsterdam UMC from Guerbet, Merck and Ferring, not related to the presented work. S.L. reports position funding from EXAMENLAB Ltd. and ownership interest by stock or partnership of EXAMENLAB Ltd (CEO). S.Q. reports being a deputy director of Tommy\'s National centre for miscarriage research, with payment received by the institution for research, staff time, and consumables for research. H.S.N. reports grants with payment to institution from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, the Danish ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark and speakers\' fees for lectures from Ferring Pharmaceuticals, Merck A/S, Astra Zeneca, IBSA Nordic and Cook Medical. She also reports to be an unpaid founder and chairman of a maternity foundation. M.-L.v.d.H. received small honoraria for lectures on RPL care. The other authors have no conflicts of interest to declare.
CONCLUSIONS: This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a
consensus between the relevant ESHRE stakeholders has been obtained.Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type.ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/
guidelines.).