Abstract

We conducted a systematic review to identify, evaluate and describe clinical practice guidelines published since 2000 for the investigation, management, and/or follow-up of recurrent miscarriage within high-income countries. We searched six major databases, eight guideline repositories and the websites of 11 professional organizations to identify potentially eligible guidelines. We assessed the quality of eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool and conducted a narrative synthesis to describe, compare and contrast the guidelines and recommendations therein. We included 32 guidelines in our review, from which we identified 373 recommendations concerning first-trimester recurrent miscarriage, across four sub-categories: structure of care (42 recommendations, 9 guidelines), investigations (134 recommendations, 23 guidelines), treatment (153 recommendations, 24 guidelines), and counselling and supportive care (46 recommendations, 9 guidelines). Most guidelines scored ‘poor’ on applicability (84%) and editorial independence (69%); and to a lesser extent stakeholder involvement (38%) and rigour of development (31%). We found varying levels of consensus across guidelines, with some conflicting recommendations. Greater efforts are required to improve the quality of evidence underpinning guidelines, the rigour of their development and the inclusion of multi-disciplinary perspectives, including those with lived experience of recurrent miscarriage.

Infographic text

• Clinical practice guidelines for recurrent miscarriage
• We conducted a systematic review: to identify, appraise, describe clinical practice guidelines, published since 2000, for the investigation, management, and/or follow-up of recurrent miscarriage within high-income countries
• We identified 32 guidelines: from which we extracted 373 recommendations concrening first trimester recurrent miscarriage: structure of care (42), investigations (134), treatment (153), counselling/supportive care (46)
• Our review found: varying levels of consensus across guidelines, with some conflicting recommendations. Quality varied. Most guidelines scored 'poor' on applicability an editorial independence
• We recommend improvements: greater efforts are required to improve the quality of evidence underpinning guidelines, the rigour of their development, and the inclusion of multi-disciplinary perspectives, inlcuding those with lived experience.