Abstract
Systematic reviews of fetal medicine can serve as a tool for translation of research
findings from a few expert centres to a wider healthcare specialty. The extent to
which reviews of fetal medicine research are systematic and unbiased is not known.
In this review of systematic reviews in fetal medicine, we have searched without language
restrictions, Medline, Embase, DARE (Database of Abstracts of Reviews of Effectiveness),
Cochrane Library (from database inception to 2005) and bibliographies of known reviews,
and contacted experts to identify potentially relevant citations of literature for
reviews of fetal medicine studies. The selected reviews were assessed for information
on framing of questions, literature search and methods of review. The search yielded
659 citations of which 84 reviews met the inclusion criteria. Most of the reviews
were in the field of fetal pathology (49/84, 59%). A majority of reviews (58/84, 69%)
specified the question to be answered but only half (44/84, 52%) addressed a focussed
question. Although 57/84 (68%) reviews had a detailed search description, only 32/84
(38%) searched without language restriction. 45/84 (54%) searched in multiple databases
and 27/84 (32%) assessed for the risk of missing studies. There was no difference
in quality between reviews of fetal pathology, screening for aneuploidy, fetal growth
and fetal therapy, except with respect to specifying the question (p < 0.03), search without language restriction (p < 0.004), assessment of risk of missing studies (p < 0.006) and study quality assessment (p < 0.002) where reviews of fetal growth performed better than other domains. Our study
reflects the paucity of good quality reviews in fetal medicine research. Existing
reviews tend to be poor in reporting methodological features. Particularly, not enough
attention is paid to assessment of validity of included studies and means to improving
reliability of results through appropriate use of meta-analysis. There is a need for
conducting further reviews and for rigour when reviewing fetal medicine research.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fetal medicine.BMJ. 1998; 316: 1580-1583
- Recent developments in fetal medicine.BMJ. 2004; 328: 1002-1006
- Noninvasive diagnosis by Doppler ultrasonography of fetal anaemia due to maternal red cell alloimmunization.N Engl J Med. 2000; 342: 9-14
- Endoscopic laser surgery versus serial amnioreduction for severe twin transfusion syndrome.N Engl J Med. 2004; 351: 136-144
- Much ado about nothing: a comparison of the performance of meta-analytical methods with rare events.Stat Med. 2007; 26: 53-77
- Evaluating non-randomised intervention studies.Health Technol Asses. 2003; 7: 1-173
- The QUORUM statement.Lancet. 2000; 355: 756-757
- Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals.JAMA. 1998; 280: 278-280
- Validation of an index of the quality of review articles.J Clin Epidemiol. 1991; 44: 1271-1278
- Users’ guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group.JAMA. 1994; 272: 1367-1371
- Intrauterine growth and gestational duration determinants.Pediatrics. 1987; 80: 502-511
- Prediction of the small for gestational age infant: which ultrasonic measurement is best?.Obstet Gynecol. 1992; 80: 1030-1038
- Perinatal transmission of human immunodeficiency virus-1 infection and maternal immunization strategies for prevention.Obstet Gynecol. 1992; 80: 458-468
- Clinical use of Doppler ultrasound in pregnancy: information from six randomised trials.Fetal Diagn Ther. 1993; 8: 247-255
- Doppler ultrasonography in high-risk pregnancies: Systematic review with meta-analysis.Am J Obstet Gynecol. 1995; 172: 1379-1387
- Absence of end-diastolic flow velocity in the umbilical artery: a review.Obstet Gynecol Surv. 1995; 50: 219-227
- Isolated fetal choroid plexus cysts and trisomy 18: a review and meta-analysis.Am J Obstet Gynecol. 1995; 172: 83-87
- Caesarean delivery for the second twin.Cochrane Database Syst Rev. 1996; : CD000047
- Calcium channel blockers for potential impaired fetal growth.Cochrane Database Syst Rev. 1995; : CD000049
- Transcutaneous electrostimulation for suspected placental insufficiency (diagnosed by Doppler studies).Cochrane Database Syst Rev. 1995; : CD000079
- Plasma volume expansion for suspected impaired fetal growth.Cochrane Database Syst Rev. 1996; : CD000167
- Fetal transfusion for red blood cell alloimmunization in pregnancy.Obstet Gynecol. 1996; 88: 137-150
- Prenatal ultrasonographic assessment of the ductus arteriosus: a review.Obstet Gynecol. 1996; 87: 630-637
- Prenatal ultrasonographic assessment of the ductus venosus: a review.Obstet Gynecol. 1996; 88: 626-632
- Does the addition of unconjugated estriol in maternal serum screening improve the detection of trisomy 21? A meta-analysis.Clin Lab Manag Rev. 1996; 10: 176-181
- Severe fetomaternal hemorrhage: a review.Obstet Gynecol Surv. 1997; 52: 372-378
- Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials.Br J Obstet Gynaecol. 1997; 104: 425-430
- Effectiveness of interventions to prevent or treat impaired fetal growth.Obstet Gynecol Surv. 1997; 52: 139-149
- Noninvasive first-trimester screening for fetal aneuploidy.Obstet Gynecol Surv. 1997; 52: 123-129
- Prenatal ultrasonographic assessment of the middle cerebral artery: a review.Obstet Gynecol Surv. 1997; 52: 444-445
- Triple-marker test as screening for down syndrome: a meta-analysis.Obstet Gynecol Surv. 1998; 53: 369-376
- Doppler ultrasound in multiple pregnancies.Baillieres Clin Obstet Gynaecol. 1998; 12: 77-89
- First trimester ultrasonography of multiple gestations: a review.Obstet Gynecol Surv. 1998; 53: 715-726
- Antepartum fetal intracranial hemorrhage, predisposing factors and prenatal sonography: a review.Am J Perinat. 1998; 15: 431-441
- Prenatal ultrasonographic diagnosis of fetal intracranial tumors: a review.Am J Perinat. 1998; 15: 319-328
- Isolated single umbilical artery anomaly and the risk for congenital malformations: a meta-analysis.J Pediatr Surg. 1998; 33: 580-585
- The incidence of, and factors leading to, parvovirus B19-related hydrops fetalis following maternal infection; report of 10 cases and meta-analysis.J Infect. 1998; 37: 28-35
- Adverse effects of chorionic villus sampling: a meta-analysis.Stat Med. 1999; 18: 2163-2175
- Intrapartum umbilical artery Doppler velocimetry as a predictor of adverse perinatal outcome: a systematic review.Br J Obstet Gynaecol. 1999; 106: 783-792
- Cardiotocography for antepartum fetal assessment.Cochrane Database Syst Rev. 2000; : CD001068
- First-trimester nuchal translucency screening for fetal aneuploidy.Am J Perinat. 1999; 16: 103-120
- Prenatal ultrasonographic diagnosis of conditions associated with potential umbilical cord compression.Am J Perinat. 1999; 16: 445-458
- Congenital toxoplasmosis: systematic review of evidence of efficacy of treatment in pregnancy.Br Med J. 1999; 318: 1511-1514
- The second-trimester fetus with isolated choroid plexus cysts: a meta- analysis of risk of trisomies 18 and 21.Obstet Gynecol. 1999; 93: 869-872
- Biophysical profile for fetal assessment in high risk pregnancies.Cochrane Database Syst Rev. 1996; : CD000038
- How useful is uterine artery Doppler flow velocimetry in the prediction of pre-eclampsia, intrauterine growth retardation and perinatal death? An overview.Br J Obstet Gynaecol. 2000; 107: 196-208
- Twin-to-twin transfusion syndrome: treatment by amniodrainage and septostomy..Eur J Obstet Gynecol Reprod Biol. 2000; 92: 141-144
- Congenital diaphragmatic hernia: a meta-analysis of mortality factors.J Pediatr Surg. 2000; 35: 1187-1197
- Pharmacogenetic screening for susceptibility to fetal malformations in women.Ann Pharmacother. 2000; 34: 639-645
- Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis.Lancet. 2000; 355: 87-92
- Sensitive and specific screening for the detection of spina bifida by echography in the second trimester: systematic review and meta-analysis.Nederlands Tijdschrift voor Geneeskunde. 2000; 144: 1736-1741
- Sonographic methods to detect fetal anemia in red blood cell alloimmunization.Obstet Gynecol Surv. 2000; 55: 240-245
- Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management.Hong Kong Med J. 2000; 6: 293-300
- Management of monoamniotic twin pregnancies: a case series and systematic review of the literature.BJOG: Int J Obstet Gynaecol. 2001; 108: 931-936
- Hospitalisation and bed rest for multiple pregnancy.Cochrane Database Syst Rev. 2001; : CD000110
- Noninvasive techniques to detect fetal anemia due to red blood cell alloimmunization: a systematic review.Obstet Gynecol. 2001; 98: 509-517
- Abuse: A risk factor for low birth weight? A systematic review and meta-analysis.CMAJ: Can Med Assoc J. 2001; 164: 1567-1572
- RhD isoimmunization and current management modalities.J Obstet Gynecol Neonatal Nursing. 2001; 30: 589-606
- Interventions for the treatment of twin-twin transfusion syndrome.Cochrane Database Syst Rev. 2001; : CD002073
- Betamimetics for suspected impaired fetal growth.Cochrane Database Syst Rev. 2001; : CD000036
- Fetal abdominal wall defects and mode of delivery: a systematic review.Obstet Gynecol. 2001; 98: 867-873
- Second-trimester ultrasound to detect fetuses with Down syndrome: a meta-analysis.JAMA. 2001; 285: 1044-1055
- Feto-maternal alloimmune thrombocytopenia: a literature review and statistical analysis.Aust N Z J Obstet Gynaecol. 2001; 41: 45-55
- Sonographic findings of the umbilical cord: implications for the risk of fetal chromosomal anomalies.Ultrasound Obstet Gynecol. 2001; 17: 536-541
- A critical appraisal of the use of umbilical artery Doppler ultrasound in high-risk pregnancies: use of meta-analyses in evidence-based obstetrics.Ultrasound Obstet Gynecol. 2001; 17: 466-476
- Isolated choroid plexus cyst in low-risk women less than 35 years old.Am J Obstet Gynecol. 2002; 187: 1246-1249
- Congenital cytomegalovirus infection: review of the epidemiology and outcome.Obstet Gynecol Surv. 2002; 57: 245-256
- Proinflammatory cytokines: a link between chorioamnionitis and fetal brain injury.J Obstet Gynaecol Can: JOGC. 2002; 24: 705-709
- Intrapartum fetal stimulation tests: a meta-analysis.Obstet Gynecol. 2002; 99: 129-134
- The effect of treatment of twin-twin transfusion syndrome on the diagnosis-to-delivery interval.Twin Res. 2002; 5: 1-4
- Monoamniotic twins: diagnosis and management.Acta Obstet Gynecol Scand. 2002; 81: 995-1000
- Systematic review of chorioamnionitis and cerebral palsy.Mental Retard Dev Disabil Res Rev. 2002; 8: 25-29
- Amniocentesis and chorionic villus sampling for prenatal diagnosis.Cochrane Database Syst Rev. 2003; : CD003252
- Prenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and meta-analysis.Obstet Gynecol. 2003; 102: 367-382
- Elective delivery of women with a twin pregnancy from 37 weeks’ gestation.Cochrane Database Syst Rev. 2003; : CD003582
- Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies.Cochrane Database Syst Rev. 2003; : CD003932
- Use of anticonvulsive drugs during pregnancy and the risk of malformations in the newborn: A meta-analysis.Revista de Neurologia. 2003; 37: 1022-1028
- Caesarean delivery for twins: a systematic review and meta-analysis.Am J Obstet Gynecol. 2003; 188: 220-227
- Screening performance of first-trimester nuchal translucency for major cardiac defects: a meta-analysis.Am J Obstet Gynecol. 2003; 189: 1330-1335
- Nutritional interventions during pregnancy for the prevention or treatment of impaired fetal growth: an overview of randomized controlled trials.J Nutr. 2003; 133: 1626S-1631S
- Hormonal placental function tests for fetal assessment in high risk pregnancies.Cochrane Database Syst Rev. 1997; : CD000108
- Use of antipsychotics during pregnancy and lactation.Tidsskrift for Den Norske Laegeforening. 2003; 123: 2033-2035
- Vitamin B12 insufficiency and the risk of fetal neural tube defects.Qjm: Monthly J Assoc Phys. 2003; 96: 289-295
- Social and ethnic inequalities in the offer and uptake of prenatal screening and diagnosis in the UK: a systematic review.Public Health. 2004; 118: 177-189
- Hormones for suspected impaired fetal growth.Cochrane Database Syst Rev. 2002; : CD000109
- Maternal nutrient supplementation for suspected impaired fetal growth.Cochrane Database Syst Rev. 2003; : CD000148
- Maternal oxygen administration for suspected impaired fetal growth.Cochrane Database Syst Rev. 2003; : CD000137
- Diagnostic performance of intracardiac echogenic foci for Down syndrome: a meta-analysis.Obstet Gynecol. 2003; 101: 1009-1016
- Acardiac twin: a systematic review of minimally invasive treatment modalities.Ultrasound Obstet Gynecol. 2003; 22: 409-419
- Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies.BMJ. 2004; 328: 261-264
- The clinical evaluation and pregnancy outcome of euploid fetuses with increased nuchal translucency.Clin Genet. 2004; 66: 426-436
- Decreased fetal movements: background, assessment, and clinical management.Acta Obstet Gynecol Scand. 2004; 83: 818-826
- Congenital abdominal wall defects: an update.Fetal Diagn Ther. 2004; 19: 385-398
- Contemporary treatments for twin-twin transfusion syndrome.Obstet Gynecol. 2005; 105: 1469-1477
Article info
Publication history
Published online: May 25, 2009
Accepted:
May 2,
2009
Received in revised form:
March 30,
2009
Received:
April 10,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
