Search strategy
We developed a systematic approach for literature search to construct the algorithm of labour progression abnormalities.
We searched the following list of databases from 1 December 2015 to 1 December 2020: The Cochrane Library and Cochrane Central Register of Controlled Trials. We searched for existing WHO guidelines and recommendations. We also searched for guidelines from the International Federation of Gynaecology and Obstetrics (FIGO), the National Institute for Health and Care Excellence (NICE), the American College of Obstetricians and Gynaecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG). We completed the search in PubMed to identify all other clinical practice guidelines, systematic reviews, meta-analyses, and relevant single studies published in the last 5 years. Searches included (labour AND (“active first stage” OR duration OR delay OR protracted OR dystocia)) ; “second stage of labour” AND (“abnormal” OR “length” OR “prolonged”); and (”Labour dystocia” OR (”Breech presentation” OR ”Brow presentation” OR ”Face presentation” OR ”Transverse presentation” OR ”Oblique presentation”) OR (labour AND (breech OR transverse OR malposition)) in Title Abstract Keyword, with all possible word variations. The search was limited to English language.
The literature review was guided by the hierarchy of evidence and prioritised WHO guidelines followed by other international or national guideline. In the absence of guidelines on a case scenario, a combination of existing studies and expert opinion was used to determine key points for consideration in the algorithm. The highest level of evidence found was used to support the decisions along the management pathway, in the order of up-to-date systematic review (with meta-analyses), up-to-date systematic review (without meta-analyses), any available systematic review, validated decision rules, randomized controlled trials, non-randomized controlled trials, observations studies, and consensus documents.
Two reviewers CG-MC independently screened the title and the abstract, extending manual searching through the reference lists of relevant articles and extracted the recommendations and supporting evidences into an excel file. Inconsistencies were resolved by a third reviewer VD.