Prediction and prevention of preterm birth: Quality assessment and systematic review of clinical practice guidelines using the AGREE II framework

Abstract

Background: Prediction of pregnancies at risk of preterm birth (PTB) may allow targeted prevention strategies.

Objectives: To assess quality of clinical practice guidelines (CPGs) and identify areas of agreement and contention in prediction and prevention of spontaneous PTB.

Search strategy: We searched for CPGs regarding PTB prediction and prevention in asymptomatic singleton pregnancies without language restriction in January 2024.

Selection criteria: CPGs included were published between July 2017 and December 2023 and contained statements intended to direct clinical practice.

Data collection and analysis: CPG quality was assessed using the AGREE-II tool. Recommendations were extracted and grouped under domains of prediction and prevention, in general populations and high-risk groups.

Main results: We included 37 CPGs from 20 organizations; all were of moderate or high quality overall. There was consensus in prediction of PTB by identification of risk factors and cervical length screening in high-risk pregnancies and prevention of PTB by universal screening and treatment for asymptomatic bacteriuria, screening and treatment for BV in high-risk pregnancies, and use of preventative progesterone and cerclage. Areas of contention or limited consensus were the role of PTB clinics, universal cervical length measurement, biomarkers and cervical pessaries.

Conclusions: This review identified strengths and limitations of current PTB CPGs, and areas for future research.

Keywords: clinical practice guideline; prediction; premature birth; preterm birth; prevention; systematic review.