Management of physical pain during induced second‐trimester medical abortions: a cross‐sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals
Engelsk titel: Management of physical pain during induced second‐trimester medical abortions: a cross‐sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals
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Författare:
Carlsson, Tommy
Email: tommy.carlsson@kbh.uu.se
Språk: Eng
Antal referenser: 37
Dokumenttyp:
Artikel
UI-nummer: 19040157
Sammanfattning
Aim: The aim was to assess the methodological quality and describe recommendations for pain management in local clinical practice guidelines about induced second‐trimester medical abortions at Swedish university and county hospitals.
Methods: In 2017, Swedish university and county hospitals that provided abortion care in the second trimester of pregnancy were contacted (n = 29), and guidelines from 25 were received (university: n = 6, county: n = 19). Guideline quality was assessed according to two systematic instruments. Recommendations were systematically assessed regarding frequency and tools for pain measurement, prophylactic pharmacologic treatment, as needed pharmacologic treatment and nonpharmacologic treatment.
Results: Overall methodological quality was poor across both instruments, as the majority of the guidelines did not fulfil the investigated quality criteria. For pain measurements, no guideline recommended measurement frequency and four recommended specific measurement tools. Prophylactic pharmacologic treatment, described in 23 (92%) guidelines, included paracetamol (n = 23, 92%), anti‐inflammatory drugs (n = 23, 92%) and opioids (n = 18, 72%). As needed pharmacologic treatment, described in 23 (92%) guidelines, included anaesthetics (n = 21, 84%), opioids (n = 21, 84%) and paracetamol (n = 1, 4%). Recommendations for as needed anaesthetics included paracervical block (n = 21, 84%), epidural analgesia (n = 16, 64%) and inhalation of nitrous oxide (n = 5, 20%). Nonpharmacologic treatments were recommended in nine (36%) guidelines.
Conclusions: The findings indicate that local clinical practice guidelines about induced second‐trimester medical abortions are of inadequate methodological quality and that a large majority lack recommendations concerning systematic pain measurements. Although most recommend prophylactic and as needed pharmacologic management, national inconsistencies exist in Sweden with regard to recommendations of epidural analgesia, nitrous oxide and nonpharmacologic methods. In Sweden, there is room for improvement in the development of these guidelines. • Published by arrangement with John Wiley & Sons.