Building an antenatal care consensus
Issue 20: 3 Oct 2005
Source: European Journal of Obstetrics & Gynecology and Reproductive Biology
2005; 122: 22-32 & 1-3
A new study has identified the extent to which guidelines on the antenatal
care of normal pregnancy are consistent between different European
countries.
Researchers at the European Institute of Health and Medical Sciences, in
Guildford, UK, set out to evaluate and compare the content of national
guidelines for routine antenatal care in the 25 countries that make up the
European Union (EU).
Antenatal care was defined as baseline clinical care of all pregnancies of
a healthy woman with an uncomplicated singleton pregnancy.
The researchers conducted a literature review and identified 37 routine
tests. They then sent a questionnaire to government health departments and
national ob/gyn organizations, asking them to specify which of the 37 tests
were recommended in official antenatal care guidelines.
Of the 25 member countries, 20 reported having such national guidelines.
Overall, these guidelines recommended 47 different tests (10 more than
identified in the literature review).
Of these, 23 tests were recommended for routine care by more than 50 percent
of the countries, and applied to more than 50 percent of the total
population. This 50 percent/50 percent criterion was considered by the
researchers to be suitable for clarifying which tests should be included in
a proposed common minimum guideline for EU member countries.
The final 23?
Writing in the European Journal of Obstetrics & Gynecology and Reproductive
Biology, the researchers say the 23 tests included three that were
recommended in all 20 countries with national guidelines. These three
universal tests were blood group, blood pressure and Rhesus factor
determination.
The 23 tests also included 12 that were recommended by more than 75 percent
of the countries (but not 100 percent). These included maternal weight,
urinalysis/bacteria, hemoglobin, urinalysis/protein, fetal position, fundal
height, and hepatitis B.
Four of the 23 tests were considered not to be sufficiently supported by
published literature. These were vaginal examination to predict a premature
ripening of the cervix, auscultation of the fetal heart rate, an oral
glucose tolerance test for gestational diabetes, and urinalyses for glucose.
The researchers say these tests require further investigation.
Concluding, they write that the suggested minimum guideline can only be
seen as the beginning of a process which might culminate in a consensus
conference at which national representatives of the relevant institutions as
well as individual health professionals can find a consensus, which can be
finally accepted by all member states.
In a brief commentary in the same issue of the journal, its editor says the
study will perform a valuable function in showing obstetricians how their
practice compares with that elsewhere, and it provides an important basis
for reflection and discussio
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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