Cooperation of Systematic Reviews in Reproductive Health

Cochrane Collaboration is an international nongovernmental organization that prepares, maintains and disseminates up-to-date reviews of health care interventions. Cochrane reviews are peer-reviewed, both after the completion of the protocol and then again after the full review is compiled. Thus, completing a systematic review is a time-consuming process, usually taking 6 - 9 months, depending on the topic and the number of studies included. Cochrane reviews are published electronically, which means that they can be easily and frequently updated. 

Each systematic review attempts to answer one clearly formulated health question. It uses rigorous and explicit methods to identify, select, and critically appraise relevant research.

Each systematic review attempts to answer one clearly formulated health question. It uses rigorous and explicit methods to identify, select, and critically appraise relevant research. The data extracted through this methodology are then analysed using standard statistical methods and presented in the review.

In contrast to the traditional narrative reviews, systematic reviews adhere to a strict scientific design. In the case of Cochrane reviews, the design requires a comprehensive search for all available data in all languages on the topic. This helps to avoid bias in the selection of data and thus ensure greater reliability of the data to be included. Explicit methodology is used to ensure reproducibility of results. The methodological rigour of a systematic review is achieved by preparation of a review protocol that gives details of how the studies are going to be searched, retrieved and critically appraised before inclusion in the review. The results of a review will only be robust if the trials included are of sufficient quality. As new data become available, each Cochrane review is updated. 

The Cochrane systematic reviews are prepared by Collaborative Review Groups that not only ensure thorough peer review but also assist in retrieval of studies, identification of unpublished studies, and translation of studies not published in English. The Programme is collaborating with seven Collaborative Review Groups, namely those on pregnancy and childbirth, fertility regulation, infectious diseases, neonatal disorders, gynaecological cancers, sexually transmitted diseases, and effective practice and organization of care.

Maternal health

The Collaborative Review Group on Pregnancy and Childbirth is concerned, inter alia, with systematic reviews in maternal health. This was the first of the Cochrane review groups. It has been active since 1992 and has produced a large number of reviews.

In 1999 alone, the Programme was substantially involved in with this group in carrying out four new reviews - on antibiotic prophylaxis for caesarean section, episiotomy, umbilical vein injection for the management of retained placenta, and care of the umbilical cord - as well protocols on vitamin A supplementation, iron deficiency anaemia, and use of the partogram. In that same year, the Programme also collaborated in updating 24 earlier reviews relating to different aspects of maternal health and fetal growth, as well in preparing reviews on urinary tract infections, mass antibiotic treatment and mild-to-moderate hypertension - all in the pregnant woman.

Fertility regulation

The Collaborative Review Group on Fertility Regulation deals with research into the ways in which people manage their sexuality and fertility. This includes how people obtain information about fertility regulation, how they make decisions regarding sexual activity, and what they do to achieve a desired family size or to space births.

The Programme has supported this review group since its inception in 1997 both with financial assistance and with representation in the editorial board. A systematic review of research on interventions for emergency contraception was published last year, as was a protocol on the acceptability of low-dose estrogen oral contraceptives containing levonorgestrel, norethindrone, desogestrel, gestodene and norgestimate. Reviews are being prepared on both medical and surgical methods for the termination of pregnancy during the first trimester, and on a comparison of the two, as well as on cervical ripening methods before first trimester termination.

Unsafe abortion

Review of research on issues related to unsafe abortion is also handled by the Collaborative Review Group on Fertility Regulation and Pregnancy and Childbirth. A systematic review of research on antibiotics for incomplete abortion was published recently, while reviews of research on medical treatments for early failure of pregnancy and on the surgical management of incomplete abortion are in preparation.

Reproductive tract infections

The Cochrane Collaboration has review groups on sexually transmitted infections, on HIV/AIDS, and on infectious diseases. One review on treatments for trichomoniasis has been published. 

Effective practice and organization of care

The Programme is also taking a leading role in an interdepartmental project aimed at "strengthening the evidence base for cost-effectiveness of integrated interventions".

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