Title: Pregnancy and Childbirth systematic reviews to support clinical guidelines
Funder: Department of Health (England)

Abstract: BACKGROUND: There has been recent concern that many research findings are not incorporated into policy or implemented into clinical practice without a considerable time lag. This has led to what has been described as avoidable waste in research. In the proposed programme of work we will concentrate on questions prioritised by clinical guideline authors so that our programme is relevant to policy needs. AIMS: To produce reviews tailored to the needs of guideline developers (specifically the National Collaborating Centre for Women and Children’s Health (NCC-WCH) producers of NICE guidelines for maternity care; and the Royal College of Obstetricians and Gynaecologists (RCOG) producers of widely used Green-top Guidelines. Such bodies need focused rapid evidence synthesis to meet their guideline development timetable. We plan a three year programme of work producing 42 new or updated Cochrane reviews and GRADE evidence profiles focusing on four topics: management of breech presentation; management of multiple pregnancy in the antenatal period; induction of labour; and diabetes in pregnancy.METHODS: Two experienced systematic reviewers will be employed to support review authors. The reviewers will either join the review teams as authors or will provide methodological support to more experienced teams Literature searches for all PCG reviews are carried out by the Group’s Trials Search Co-ordinator (TSC) who searches the Cochrane PCG’s Trials Register on behalf of authors. The Trials Register is maintained by the TSC and contains trials identified from: monthly searches of the Cochrane Central Register of Controlled Trials (CENTRAL); regular searches of MEDLINE CINAHLand EMBASE; handsearches of 30 journals and the proceedings of major conferences; weekly current awareness alerts for a further 44 journals plus monthly BioMed Central email alerts. Details of the search strategies for CENTRAL MEDLINE CINAHL and EMBASE the list of handsearched journals and conference proceedings and the list of journals reviewed via the current awareness service can be found in the ‘Specialized Register’ section within the editorial information about the Cochrane Pregnancy and Childbirth Group. In the proposed programme of work searches will be updated weekly and the latest search date will be within 3 months of review publication. We will include randomised controlled trials examining the effects of interventions in the above four topic areas. Selection of studies and data extraction will be carried out independently by two review authors. Two review authors will independently assess risk of bias for each study for seven bias domains:(1) Random sequence generation (checking for possible selection bias)(2) Allocation concealment (checking for possible selection bias)(3.1) Blinding of participants and personnel (checking for possible performance bias)(3.2) Blinding of outcome assessment (checking for possible detection bias)(4) Incomplete outcome data (checking for possible attrition bias due to the amount nature and handling of incomplete outcome data)(5) Selective reporting (checking for reporting bias)(6) Other bias (checking for bias due to problems not covered by (1) to (5) above)(7) Overall risk of biasFor dichotomous data we will present results as summary risk ratio with 95% confidence intervals.For continuous data we will use the mean difference if outcomes are measured in the same way between trials. We will use the standardised mean difference to combine trials that measure the same outcome but use different methods.We will carry out statistical analysis using the Review Manager software (RevMan 2012) using standard Cochrane methods.Where appropriate the impact of the level of bias and between study heterogeneity will be explored through undertaking sensitivity analyses.We will set out the main findings of each review in Summary of Findings tables prepared using GRADEprofiler software. For primary outcomes estimates of absolute and relative effects will be provided along with the number of participants and studies contributing data. For each outcome the quality of the evidence will be assessed using the GRADE approach (evidence graded for risk of bias inconsistency indirectness imprecision and possible reporting bias or other considerations). We will also provide brief narrative summaries setting out main findings and a broad assessment of evidence quality. The programme will result in 42 new or updated reviews published in the Cochrane Library.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH