背景:指导血管前置的诊断和治疗的数据有限。目前,我们所知道的主要是基于病例报告或系列和队列研究.
目的:本研究旨在使用焦点小组讨论和Delphi技术,系统地收集和分类专家意见,并就血管前置的诊断和临床管理达成共识。
方法:进行了4轮焦点小组讨论和3轮Delphi调查,调查了一个关于血管前置的国际专家小组。专家是根据他们关于vasaprevia的出版记录选出的。首先,我们召集了一个由20名专家组成的焦点小组讨论小组,并就前置血管的诊断和治疗中尚未解决的问题达成一致.然后将3轮匿名电子调查发送给整个专家小组。提出了关于前置血管的诊断和管理的调查问题,专家被要求以5分的李克特量表(从“强烈不同意”=1到“强烈同意”=5)进行评分。共识定义为5分的中位数。在对每一轮的回应之后,中位评分≤3分的任何陈述均被视为未达成共识,因此被排除.对中位数为4分的陈述进行了修订,并在下一轮中重新提交给专家。然后将共识和非共识声明汇总。
结果:共邀请了68名国际专家参与研究,57人参加。专家来自5大洲的13个国家,对发表的关于前置血管的队列研究的贡献超过80%,以及国家和国际社会的指导方针。完成率为84%,93%,第一个是91%,第二,第三轮,分别,71%的人完成了所有3轮比赛。小组就26项关于前置血管的诊断和管理要点的声明达成共识,其中包括:(1)虽然胎儿血管与宫颈内口之间的距离没有一致定义前置血管,定义不应限于2厘米的距离;(2)所有妊娠均应通过常规检查胎盘索插入,并在孕中期解剖扫描时对宫颈上方区域进行彩色多普勒扫描,以筛查血管前置;(3)当在孕中期发现低洼胎盘或前置胎盘时,应在约32周进行经阴道多普勒超声检查,以排除前置血管;(4)对无早产危险因素的无症状患者进行门诊治疗是合理的;(5)无症状的前置血管患者应在妊娠35至37周进行定期剖宫产分娩;(6)对常规住院没有协议,避免性交,或使用三维超声诊断血管前置。
结论:通过焦点小组讨论和德尔菲过程,一个国际专家小组就该定义达成共识,筛选,临床管理,和前置血管的分娩时间,这可以为新临床指南的制定提供信息。
BACKGROUND: There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies.
OBJECTIVE: This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique.
METHODS: A 4-round focus group discussion and a 3-round Delphi
survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a focus group discussion panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A 3-round anonymous electronic
survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa, which the experts were asked to rate on a 5-point Likert scale (from \"strongly disagree\"=1 to \"strongly agree\"=5).
Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of ≤3 were deemed to have had no consensus and were excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and nonconsensus statements were then aggregated.
RESULTS: A total of 68 international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on 5 continents and have contributed to >80% of published cohort studies on vasa previa, as well as national and international society
guidelines. Completion rates were 84%, 93%, and 91% for the first, second, and third rounds, respectively, and 71% completed all 3 rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including the following: (1) although there is no agreement on the distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2-cm distance; (2) all pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; (3) when a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at approximately 32 weeks to rule out vasa previa; (4) outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; (5) asymptomatic patients with vasa previa should be delivered by scheduled cesarean delivery between 35 and 37 weeks of gestation; and (6) there was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa.
CONCLUSIONS: Through focus group discussion and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical
guidelines.