Evaluation of adherence to French clinical practice guidelines in the management of pregnancy loss issued by the French College of Obstetricians and Gynecologists, one year after publication: A vignette-based study

Abstract : Objectives: To assess the adhesion of French obstetricians and gynecologists to the French clinical practice guidelines for pregnancy loss, issued by the French College of Obstetricians and Gynecologists, one year after publication.Methods: An online vignette-based study was emailed to a sample of French obstetricians and gynecologists to compare their management of women with missed early miscarriage and incomplete early miscarriage. A descriptive statistical analysis was performed comparing the rates of appropriate management for these two indications before and after the release of the guidelines.Results: Of the 404 specialists contacted, 143 completed the questionnaire. Forty-three percent stated that they had changed their practices following the release of the guidelines. The rate of adhesion was moderate for the management of missed early miscarriage (53% after publication of the guidelines versus 42% before, P = 0.001) with a trend to avoid watching-and-waiting management. The rate of adhesion was poor for the management of incomplete early miscarriage (43% after the publication of the guidelines versus 27% before, P < 0.001) with a lower use of misoprostol.Conclusion: Adhesion to the French guidelines appears to be moderate for the management of missed early miscarriage and low for the management of incomplete early miscarriage.