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.