Clinical practice in recurrent pregnancy loss care: identifying possible barriers for the implementation of an evidence-based guideline

Abstract

Abstract Background Practice variation in recurrent pregnancy loss (RPL) care is common. International guidelines vary in their recommendations for the management of RPL couples, which could lead to an increase of cross border reproductive care. Currently, the Dutch RPL guideline is being adapted from the European Society for Human Reproduction and Embryology (ESHRE) guideline. We aim to identify possible barriers in the implementation of evidence-based RPL care as stipulated in the current guidelines. These barriers could be considered in the development of a new guideline to promote adherence to new recommendations. Methods A nationwide survey on the management of RPL patients was conducted across all 107 hospital-based obstetrics and gynaecology practices in the Netherlands. The survey was sent via the Dutch Society for Obstetricians and Gynaecologists to all affiliated clinicians. The questionnaire consisted of 36 questions divided in four sections: clinician’s demographics, RPL definition, investigations and therapy. The data were compared to the recommendations given by guideline of the Dutch Society for Obstetricians and Gynaecologists and of the ESHRE, and university hospitals were compared to non-university hospitals. Results All hospital-based practices (100%; n=107) filled in the online questionnaire, eight of which were university hospitals, 62 teaching and 37 non-teaching hospitals. The majority of respondents defined RPL similarly, as two or more pregnancy losses (87.4%), not obligatory consecutive (93.1%). Biochemical pregnancies were more often included by university hospitals (57.0% (n=49) vs 41.7% (n=128); p=0.012) by non-university hospitals. More than half of respondents routinely perform thrombophilia screening, although not advised by the ESHRE, while thyroid function, thyroid auto-immunity and β2-glycoprotein antibodies in the context of antiphospholipid syndrome (APS) are recommended but investigated by less than half of respondents. Finally, university hospitals appear to emphasize lifestyle changes more often than non-university hospitals. Conclusion While many clinicians perform investigations recommended by the ESHRE, there is a considerable variation of RPL practice in the Netherlands. We identified possible barriers for RPL guideline implementation in the Netherlands, and possibilities for the ESHRE to focus on implementation strategies in collaboration with national societies. This will improve the quality of care provided to RPL patients and may diminish the necessity felt by patients to turn to multiple opinions or cross border reproductive care.