Management of recurrent miscarriage: evaluating the impact of a guideline.

BACKGROUND Little is known on the actual diagnostic and therapeutic management of recurrent miscarriage and the impact of introducing guidelines on this topic. The objective of this study was to evaluate any changes in the management of recurrent miscarriage among Dutch gynaecologists after the introduction of the Dutch guideline 'Recurrent Miscarriage' in 1999. METHODS Questionnaires were sent to all practices for obstetrics and gynaecology in the Netherlands. Data concerned definition, diagnosis and treatment of recurrent miscarriage. Results were compared with a similar study conducted before the introduction of the guideline and with the recommendations in the guideline. RESULTS The response rate was 83%. Regarding gestational age, only 3% of the respondents used the definition as advised in the guideline. After the introduction of the guideline, thrombophilia factors were tested more frequently, anticoagulants were prescribed more frequently and more respondents reported to correct uterine malformations. Therapies not described in the guideline, e.g. donor insemination and oocyte donation, were still applied. CONCLUSIONS The adherence to the Dutch guideline 'Recurrent Miscarriage' was rather poor, presumably due to guideline-related as well as physician-related barriers. Too many diagnostic tests and ineffective therapeutic interventions were performed. This study demonstrates the importance of appropriate implementation and revision.

[1]  Luke Vale,et al.  Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. , 2006, Journal of general internal medicine.

[2]  Luke Vale,et al.  Toward evidence-based quality improvement , 2006 .

[3]  R. Grol,et al.  Barriers to physician adherence to a subfertility guideline. , 2005, Human reproduction.

[4]  E. Jauniaux,et al.  Updated and revised nomenclature for description of early pregnancy events. , 2005, Human reproduction.

[5]  O. Christiansen.  Evidence-based investigations and treatments of recurrent pregnancy loss. , 2005, Current opinion in obstetrics & gynecology.

[6]  V. Rasch.  Cigarette, alcohol, and caffeine consumption: risk factors for spontaneous abortion , 2003, Acta obstetricia et gynecologica Scandinavica.

[7]  R. Farquharson,et al.  Types of pregnancy loss in recurrent miscarriage: implications for research and clinical practice. , 2002, Human reproduction.

[8]  L. Nardo,et al.  High serum luteinizing hormone and testosterone concentrations do not predict pregnancy outcome in women with recurrent miscarriage. , 2002, Fertility and sterility.

[9]  B. Tarlatzis,et al.  Clinical implications of uterine malformations and hysteroscopic treatment results. , 2001, Human reproduction update.

[10]  L. Regan,et al.  Epidemiology and the medical causes of miscarriage. , 2000, Bailliere's best practice & research. Clinical obstetrics & gynaecology.

[11]  A. Heintz,et al.  Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women , 2000, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[12]  C. Conlon,et al.  A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage. , 1999, Human reproduction.

[13]  M. Cabana,et al.  Why don't physicians follow clinical practice guidelines? A framework for improvement. , 1999, JAMA.

[14]  W A Wilson,et al.  International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. , 1999, Arthritis and rheumatism.

[15]  L. Regan,et al.  Polycystic ovaries and recurrent miscarriage--a reappraisal. , 1999, Human reproduction.

[16]  G. Bonsel,et al.  GEEN EENDUIDIGHEID OVER DEFINITIE, DIAGNOSTIEK EN BEHANDELING VAN HABITUELE ABORTUS IN NEDERLAND , 1999 .

[17]  F. Bieber,et al.  Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception. , 1988, The New England journal of medicine.

[18]  O. Christiansen,et al.  Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. , 2006, Human reproduction.

[19]  L. Regan,et al.  Recurrent miscarriage. , 2006, Lancet.

[20]  Monika Lelgemann,et al.  The AGREE (Appraisal of Guidelines Research and Evaluation) instrument. , 2005, Zeitschrift fur arztliche Fortbildung und Qualitatssicherung.