Search strategy
A systematic database search for citations about LGE during pregnancy was performed by the first author (ADL) and an information specialist (WMB) on May 26th 2014. This search was performed in the following databases: Embase (including MEDLINE), Medline OvidSP, Cochrane Central Register of Controlled Trials, Web-of-Science, Google scholar and Pubmed. The detailed digital search strategy is provided in the Additional file 1.
Review and study selection process
Titles and abstracts identified through the search strategy were assessed by two independent reviewers for potential eligibility. All original research articles, including case reports, were included. References were excluded on title and abstract based on the following exclusion criteria: all references published before 1990, all references not in English, all references regarding different subjects, conference proceedings and animal studies. Disagreements were settled in consensus and, if necessary, after discussion with a third independent reviewer. The manuscripts deemed potentially eligible for inclusion were obtained for full text review. The full texts were assessed by the two independent reviewers ((1) ADL and (2) BG and PHAW), using pre-defined eligibility criteria. Articles were included when the study population consisted of at least one pregnant female and LGE was performed during pregnancy. Articles on ectopic pregnancy were excluded, as well as articles without outcome information on the mother and the child. Discussions with the third independent (CJW) reviewer were used to resolve disagreements.
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Data extraction
Data from the eligible reports was extracted using a standardized form by the primary reviewers. Differences in the extracted data were resolved through consensus or, if necessary, discussion with the third independent reviewer. For each study, the following data was extracted considering the following:
- 1.
Procedure (type of endoscopy, gestational week of endoscopy)
- 2.
Participants (including age, indication for endoscopy)
- 3.
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Interventions (additional surgery, medical treatment, gestational week of other interventions)
- 4.
Outcomes (including birth outcomes, fetal adverse events, maternal adverse events, gestational week of adverse events)
Definitions
Sigmoidoscopy was defined as endoscopic intubation no further than the splenic flexure, and colonoscopy was defined as endoscopic intubation beyond the splenic flexure.
Miscarriages or spontaneous abortion were defined as fetal loss prior to 20th gestational week. Stillbirth or fetal demise was defined as fetal loss beyond the 20th gestational week. Premature delivery was defined as delivery before gestational week 37.
A temporal relation between an adverse event and LGE was found as plausible if the adverse event occurred within 1 week of the LGE and defined as unlikely when the adverse event occurred more than 1 week after endoscopy.
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An etiological relation was found plausible if a temporal relation existed and, in addition, based on sound, medical reasoning the adverse event could be linked to the LGE. Etiological relations were classified on an ordinal scale as: unlikely, possible, probable and likely. These relations were determined in consensus, based on the following definitions.
Unlikely relation: LGE or its preparation or sedation cannot explain maternal/fetal adverse event, based on sound, medical reasoning. Elective abortions and induced labor or elective caesarean sections were all classified as unlikely related to LGE.
Possible relation: LGE or its preparation or sedation could explain maternal/fetal adverse event, however in between LGE and the occurrence of the adverse event another intervention was also performed (e.g. laparotomy).
Probable relation: LGE or its preparation or sedation could explain maternal/fetal adverse event, no other interventions between LGE and adverse event were performed, however, the underlying maternal disease could still also explain the adverse event.
Likely relation: LGE or its preparation or sedation could explain maternal/fetal adverse event, no other interventions between adverse event were performed, maternal disease does not seem etiologically related to the adverse event.
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