Consensus Statements for Assessment and Management of Threatened Miscarriage in the First Trimester in Pakistan: A Three-Step Modified Delphi Approach.

Autor:	Iqbal M; Obstetrics and Gynecology, Integrated Medical Care Hospital, Lahore, PAK., Zubair M; Obstetrics and Gynecology, Azad Jammu Kashmir Medical College, Muzaffarabad, PAK., Saeed Awan A; Obstetrics and Gynecology, Fauji Foundation Hospital, Rawalpindi, PAK., Khan Y; Obstetrics and Gynecology, Hameed Latif Hospital, Lahore, PAK., Yasmin H; Obstetrics and Gynecology, Jinnah Postgraduate Medical Center (JPMC), Karachi, PAK., Rahim R; Obstetrics and Gynecology, Lady Ready Hospital, Peshawar, PAK., Srichand P; Obstetrics and Gynecology, Isra University Hospital, Hyderabad, PAK., Pal SA; Epidemiology, Concept Fertility Center, Karachi, PAK., Mazhar SB; Obstetrics and Gynecology, Pakistan Institute of Medical Sciences, Islamabad, PAK., Sohail R; Epidemiology and Public Health, Hameed Latif Hospital, Lahore, PAK., Zaman F; Obstetrics and Gynecology, Hameed Latif Hospital, Lahore, PAK., Ali S; Medical Affairs, Established Pharmaceutical Division, Abbott Laboratories (Pakistan) Limited, Karachi, PAK., Ali T; Medical Affairs, Established Pharmaceutical Division, Abbott Laboratories (Pakistan) Limited, Karachi, PAK.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jul 22; Vol. 16 (7), pp. e65079. Date of Electronic Publication: 2024 Jul 22 (Print Publication: 2024).
DOI:	10.7759/cureus.65079
Abstrakt:	Background and Objective: It aimed to develop an expert consensus regarding the risk assessment, diagnosis, and threatened miscarriage management during the first trimester in Pakistan. Methods: A three-step modified Delphi method was applied to develop the consensus. Eleven specialized obstetricians and gynecologists participated in its development. If 75% or higher agreement level was attained on each assertion, it was declared as a consensus. Results: Age of 35 or above, previous history of two or more previous miscarriages, and direct strong trauma were considered to be threatened miscarriage risk factors. Infection was discussed and specified to include specific infectious diseases, like malaria, and COVID-19 as a risk factor. The experts agreed from the first time on considering endocrinological disorders, thrombophilia, and lifestyle variables as threatened miscarriage risk factors. They proposed adding a statement concerning acquired thrombophilia which was accepted unanimously. Finally, experts agreed on the importance of educating pregnant women about factors whose risk can be modified by modifying their behavior. As for diagnosis statements, it was agreed to be trifold: physical examination, imaging, and laboratory testing. Physical examination included abdominal and pelvic exams but focused more on vaginal examination with speculum to identify bleeding severity and etiology. The statements regarding the imaging approaches to diagnose threatened miscarriage in the first trimester achieved a consensus in most statements. TVS was recommended to check on uterine structural abnormalities, fetus viability focusing on heartbeat and crown-to-rump length, gestation sac size and emptiness, subchorionic hematoma, and ectopic pregnancy. Each was defined on how to identify and diagnose in separate statements. Statements about laboratory tests indicated the need for human chorionic gonadotropin hormone assessment whether serial or once is dependent on the ultrasound. Recommended hematologic investigations include complete blood count for anemia, Rh factor for potential bleeding risk and in special cases, thrombophilia assessment is undertaken. The first and foremost management aspect was follow-up while most management statements were controversial, and some were altogether removed with only some reaching agreement after discussion. Conclusion: These consensus statements aggregated the best available evidence and experts' opinion-supported statements to improve patient education, risk assessment, diagnosis, and evaluation as well as management of threatened miscarriage during the first trimester in Pakistan. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: Tabrez Ali and Sobia Ali are salaried and full-time employees of Abbott Laboratories (Pakistan) Limited. (Copyright © 2024, Iqbal et al.)
Databáze:	MEDLINE
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