[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice].
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Deffieux Xavier, Rousset-Jablonski Christine, Gantois Adrien, Brillac Thierry, Maruani Julia, Maitrot-Mantelet Lorraine, Mignot Stéphanie, Gaucher Laurent, Athiel Yoann, Baffet Hortense, Bailleul Alexandre, Bernard Valérie, Bourdon Mathilde, Cardaillac Claire, Carneiro Yaritza, Chariot Patrick, Corroenne Romain, Dabi Yohann, Dahlem Laurence, Frank Sophie, Freyens Anne, Grouthier Virginie, Hernandez Isabelle, Iraola Elisabeth, Lambert Marie, Lauchet Nadege, Legendre Guillaume, Le Lous Maela, Louis-Vahdat Christine, Martinat Sainte-Beuve Anne, Masson Marine, Matteo Caroline, Pinton Anne, Sabbagh Emmanuelle, Sallee Camille, Thubert Thibault, Heron Isabelle, Pizzoferrato Anne-Cécile, Artzner France, Tavenet Arounie, Le Ray Camille, Fauconnier Arnaud
Аннотация
MATERIAL AND METHODS: A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.
METHODS: The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.
RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature.
CONCLUSIONS: The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.