NICE guideline on antenatal care: routine care for the healthy pregnant woman—recommendations on the use of complementary therapies do not promote clinical excellence

Objetivo: realizar recomendaciones para la prevención, detección temprana y tratamiento de las complicaciones del embarazo en Colombia.Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta guía fue adaptada de la GPC “Antenatal care: routine care for the healthy pregnant woman” (National Institute of Care and Health Excellence -NICE -2008) y actualizada por medio de procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresadas por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN).Resultados: se priorizaron 30 preguntas clínicas, las cuales generaron diversas recomendaciones relacionadas con la organización administrativa del control prenatal, el manejo de las molestias más frecuentes, las actividades para garantizar el bienestar materno-fetal e indicaciones para detectar precozmente aquellas patologías que pueden alterar el embarazo de curso normal, entre otras.Conclusión: se presenta una versión resumida de las recomendaciones y evidencia de esta sección, que se espera sea adoptada por los profesionales de la salud encargados de la atención del embarazo en el país para disminuir la morbilidad y mortalidad asociada a la gestación. Palabras clave: guías de práctica clínica, práctica clínica basada en la evidencia, embarazo, atención prenatal, Colombia.

Download Full-text

VP14 Screening Recommendations For Socioeconomic Disadvantages In Pregnancy

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317003087 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 152-152

Author(s):

Katharina Rosian

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Clinical Excellence ◽

Advisory Council ◽

International Studies ◽

Socioeconomically Disadvantaged ◽

Nice Guideline ◽

Australian Health ◽

Increased Risk ◽

Austrian Population

INTRODUCTION:In 2015, 18.3 percent of the Austrian population were at risk of poverty and social exclusion - about 211,000 (20 percent) women aged 20–39 years were affected. International studies report that poverty may lead to an increased risk of complications and pathologies during pregnancy. Further, children who grow up in poverty often have poorer long-term health outcomes.METHODS:In order to identify recent guidelines (2011-2016) a comprehensive handsearch was conducted in the guideline databases National Guideline Clearinghouse (NGC) and Guidelines International Network (GIN). Moreover, a handsearch for systematic reviews and primary studies was conducted in PubMed.RESULTS:Two guidelines, the British National Institute for Health and Clinical Excellence (NICE) Guideline “Pregnancy and Complex Social Factors”, as well as the Australian Health Ministers' Advisory Council (AHMAC) Guideline “Antenatal Care”, address socioeconomic disadvantages of women during antenatal care. The recommendation of the AHMAC is that pregnancy care should be offered to all pregnant women. In addition, an individual approach will help to pay particular attention to socioeconomic factors and to incorporate them in routine examinations. NICE recommends in its guideline, affected women should be supported in order to ensure adequate prenatal care. NICE also defines criteria which are used to identify pregnant women who are in greater need of support. The only identified study developed and tested a tool for the identification of patients affected by poverty. The authors of this Canadian pilot study concluded that the defined questions helped to identify socioeconomically disadvantaged persons during anamnesis without stigmatizing.CONCLUSIONS:Due to the proven link between poverty and health risks, special attention must be paid to socioeconomically disadvantaged pregnant women. Research on non-stigmatizing instruments, which can identify vulnerable women, is of great importance. In addition to social policy measures, it is necessary to ensure that low-threshold services are available for socioeconomic disadvantaged women and their children.

Download Full-text

Listeria Septicaemia in a Young Healthy Pregnant Woman

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.1995.tb01991.x ◽

1995 ◽

Vol 35 (3) ◽

pp. 316-317 ◽

Cited By ~ 1

Author(s):

A. Kurup ◽

G. Kumarasinghe ◽

S. Arulkumaran ◽

S. S. Ratnam

Keyword(s):

Pregnant Woman ◽

Healthy Pregnant Woman

Download Full-text

Using family atopy scores to identify the risk of atopic dermatitis in infants

Paediatrica Indonesiana ◽

10.14238/pi54.6.2014.330-7 ◽

2014 ◽

Vol 54 (6) ◽

pp. 330

Author(s):

Melisa Anggraeni ◽

Ketut Dewi Kumara Wati ◽

Ketut Tangking

Keyword(s):

Atopic Dermatitis ◽

Cohort Study ◽

Pregnant Woman ◽

Environmental Factors ◽

Antenatal Care ◽

Early Life ◽

Early Interventions ◽

Chi Square

Background Atopic dermatitis is the first manifestation ofallergic disease in early life. Early interventions may prevent thedevelopment of allergy disease. Allergy trace cards have beenused to identify the level of allergic risk, based on family atopyscores. Because environmental factors may also influence thedevelopment of atopic dermatitis, the usefulness of the allergytrace card needs to be reevaluated.Objective To compare the incidence of atopic dermatitis ininfants aged 0-4 months with total family atopy scores of > 0 tothose with scores of 0.Methods We conducted this cohort study from June 1, 2012 toDecember 31, 2012 at Sanglah Hospital, Denpasar. Family atopyscore was tabulated from all pregnant woman in the ObstetricOutpatient Clinic and the Maternity Room. Subjects were dividedinto two groups based on their total family atopy score: those withscores > 0 and those with scores of 0. The appearance of atopicdermatitis symptoms in the infants were evaluated until theyreached 4 months of age. The incidence of atopic dermatitis intwo groups was compared using Chi-square test.Results The incidence of atopic dermatitis in this study was 10.9%.The group with total family atopy scores of 0 had a significantlyhigher incidence of atopic dermatitis than the group with scores> 0 (adjusted RR 22.5; 95%CI 8.8 to 57.0; P = 0.001).Conclusion The incidence of atopic dermatitis is higher ininfants with total family atopy score > 0 and this group has a 22.5times higher risk of atopic dermatitis compared to infants withtotal family atopy score of 0. Allergy trace cards are relevant indifferentiating the risk of atopy with regards to development ofatopic dermatitis. We suggest that family atopy scores be evaluatedduring antenatal care in order to limit the development of atopicdermatitis in infants.

Download Full-text

From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17238946 ◽

2020 ◽

Vol 17 (23) ◽

pp. 8946

Author(s):

Bente Dahl ◽

Kristiina Heinonen ◽

Terese Elisabet Bondas

Keyword(s):

Antenatal Care ◽

Transition To Parenthood ◽

Evidence Synthesis ◽

Routine Care ◽

Risk Identification ◽

Qualitative Evidence Synthesis ◽

Model Of Care ◽

Her Family ◽

Multiple Challenges ◽

Personal Challenges

Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives’ experiences of providing antenatal care, attending to clients’ individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives’ wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives’ provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.

Download Full-text

Remember Pregnancy is a State of Health

From Here to Maternity ◽

10.1332/policypress/9781447349341.003.0003 ◽

2018 ◽

pp. 38-50

Author(s):

Ann Oakley

Keyword(s):

Pregnant Woman ◽

General Practitioner ◽

Antenatal Care ◽

Local Authority ◽

Medical Condition ◽

Medical Profession ◽

State Of Health ◽

Normal Work ◽

In Pregnancy ◽

Hospital Clinic

This chapter argues that pregnancy is a medical condition — a condition to be monitored by doctors. Between seven and eighteen visits to the general practitioner (GP), local authority, or hospital clinic were made during pregnancy by the sample women for antenatal care: the average was thirteen. Going to the doctor suggests illness, and two other features of illness are associated with pregnancy in modern industrialised society: a pregnant woman, like other ‘patients’, is allowed to give up her normal work, and is encouraged to hand over responsibility for the management of her condition to others (the medical profession). Moreover, pregnancy produces unpleasant symptoms, each of which, in other circumstances, can be a sign of illness. Even in pregnancy some of these require medication, a habit not normally associated with health.

Download Full-text

The process of producing a “NICE” guideline

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00001135 ◽

2010 ◽

Vol 19 (3) ◽

pp. 211-213 ◽

Cited By ~ 1

Author(s):

David Goldberg

Keyword(s):

United Kingdom ◽

Evidence Based Medicine ◽

Clinical Guideline ◽

Clinical Excellence ◽

The Other ◽

Evidence Based ◽

Nice Guideline ◽

The United Kingdom ◽

The One ◽

Based Medicine

SUMMARYThis paper describes the process of preparing a Clinical Guideline for “NICE”, the National Institute for Health and Clinical Excellence in the United Kingdom. The procedure involves the group appointed to prepare the guideline relating to the various “stakeholders” who have an interest on the one hand, and satisfying the fairly demanding standards set by NICE on the other. The strengths and limitations of the approach based on evidence based medicine are discussed.

Download Full-text

Factors Affecting the Utilization of a Minimum of Four Antenatal Care Services in Ethiopia

Obstetrics and Gynecology International ◽

10.1155/2019/5036783 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Garoma Wakjira Basha

Keyword(s):

Antenatal Care ◽

Rural Areas ◽

Wealth Index ◽

Complete Information ◽

Healthcare Services ◽

Household Wealth ◽

Routine Care ◽

Factors Affecting ◽

Poor Households ◽

Nationally Representative

Background. Antenatal care is defined as the routine care of pregnant women provided between conception and the onset of labor. This study is aimed to identify factors affecting the utilization of antenatal care (ANC) services in Ethiopia. Methods. The study used data from the nationally representative 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 7,167 mothers who gave birth within five years preceding the 2016 EDHS whose complete information was available in the survey were included in this study. Logistic regression statistical analyses were used to identify factors associated with the utilization of a minimum of 4 ANC services in Ethiopia. Results. Among the 7,167 women included in this study, 2,598 (36.6%) had utilized a minimum of 4 ANC services in Ethiopia. This study showed that factors such as place of residence, region, mothers’ education level, household wealth index, desire for pregnancy, frequency of reading newspaper, frequency of listening to radio, and frequency of watching TV were associated with the utilization of a minimum of four ANC services at 5% level of significance in Ethiopia. Conclusion. Strategies to increase the accessibility and availability of healthcare services are important particularly for communities in rural areas. Financial support that enables mothers from poor households to use health services will be beneficial. Health promotion programs targeting mothers with no education are vital to increase their awareness about the importance of antenatal services.

Download Full-text

Sunburn as a Cause of Unexpected Neutrophilia in a Healthy Pregnant Woman

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/8392127 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Robert Harper

Keyword(s):

Differential Diagnosis ◽

Pregnant Woman ◽

Neutrophil Count ◽

Systemic Response ◽

Healthy Pregnant Woman ◽

Blood Tests ◽

Routine Blood ◽

Assessment Unit

Background. Neutrophilia has a broad differential diagnosis and represents a systemic response to an infection or other inflammatory pathologies. Case. A 31-year-old woman, Gravida 3, Para 2 at 28 weeks of gestation, presented to the day assessment unit following routine blood tests that showed an unexpected marked neutrophilia. The underlying cause of the neutrophilia was sunburn. The sunburn recovered and her neutrophil count spontaneously normalised. Conclusion. Clinicians can add sunburn to the broad differential diagnosis of neutrophilia.

Download Full-text