PREGNANCY MATTERS
This clinical guideline concerns the management of hypertensive disorders inpregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancycomplicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.
This clinical guideline contains recommendations for the management of diabetes and its complications in women who wish to conceive and those who are already pregnant. The guideline builds on existing clinical guidelines for routine care during the antenatal, intrapartum and postnatal periods. It focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies.
The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).
Bacterial vaginosis (BV) is the most common lower genital tract syndrome among women of reproductive age. This report will be used by the United States Preventive Services Task Force (USPSTF) to update its 2001 recommendation on screening and treatment for bacterial vaginosis in pregnancy. This update report will focus on three critical key questions related to screening, treatment, and adverse effects of screening and/or treatment on pregnancy outcomes in women asymptomatic for bacterial vaginosis at low, average, and high risk for preterm delivery.
Members of the US Preventive Services Task Force (USPSTF) defined the scope of this update, in cooperation with the Agency for Healthcare Research and quality (AHRQ) and the Oregon Evidence Based Practice Center (EPC) personnel. The Task Force's goals for this update were to address the gaps in the literature revealed in the 1996 USPSTF recommendations. These gaps related to the accuracy of risk assessment questionnaires in children with varying blood lead levels, the population prevalence at which to change from targeted screening to universal screening, the effectiveness of interventions to lower lead levels, and cost-effectiveness analyses of lead screening programs.
To update its 1996 guidelines, the U.S. Preventive Services Task Force (USPSTF) commissioned this brief update of the evidence on selected questions about screening for iron deficiency anemia (IDA) in children, adolescents, and pregnant women.
The review concluded that among women with foetal death in the second or third trimester, vaginal misoprostol was less effective than oral misoprostol at achieving uterine evacuation within 24 hours, but not within 48 hours. In view of the limitations of the evidence base, small sample sizes and heterogeneity between studies, the authors' conclusions may not be reliable.
The review assessed the safety of aspirin during pregnancy. The authors concluded that aspirin reduced the rate of pre-term deliveries, but not perinatal death, in women with moderate to high-risk pregnancies. The authors' conclusions seem appropriate. However, the lack of detail about the methodology of the review makes the reliability of the conclusions uncertain.
Women who have had a previous preterm birth are at increased risk of having another premature birth. Babies who are born before the 37th week of pregnancy, and particularly those born before the 34th week, are at greater risk of suffering problems at birth and of disability in childhood. 'Specialised' antenatal clinics have been suggested for women at high risk of a preterm birth as a way of improving health outcomes for the women and their infants. This review of three randomised controlled trials involving 3400 women in the USA found that there was no reduction in the number of preterm births in women attending specialised antenatal clinics. The results were difficult to interpret, as the trials were conducted in slightly different ways and offered slightly different care. The trials were all conducted in the 1980s, before the introduction of many of the screening tests currently offered in specialised antenatal clinics such as ultrasound assessment of cervical length. There was no information available on the effect of specialised antenatal care on maternal wellbeing or long‐term outcome.
Bibliographic details: Wang T, Liu SY, Xu LZ, Xing AY, Liu GJ. Systematic review of effects for S-adenosyl-L-methionin on impROving the pregnancy outcomes of intrahepatic cholestasis of pregnancy.
We reviewed the evidence regarding the outcomes of interventions used in ovulation induction, superovulation, and in vitro fertilization (IVF) for the treatment of infertility. Short-term outcomes included pregnancy, live birth, multiple gestation, and complications. Long-term outcomes included pregnancy and post-pregnancycomplications for both mothers and infants.
This guideline has been developed to advise on the clinical management of and service provision for antenatal and postnatal mental health. The guideline recommendations have been developed after careful consideration of the best available evidence by a multidisciplinary team of healthcare professionals, women who have experienced mental health problems in the antenatal or postnatal period and guideline methodologists. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for women with antenatal and postnatal mental health problems while also emphasising the importance of the experience of care for women and their families and carers
Caesarean section (CS) is the end point of a number of care pathways hence it is not possible to cover all the clinical decisions and pathways which may lead to a CS in one guideline. This evidence based guideline has been developed to help ensure consistency of quality of care experienced by women having CS. It provides evidence based information for health care professionals and women about: the risks and benefits of CS; certain specific indications for CS; effective management strategies which avoid CS; anaesthetic and surgical aspects of care; interventions to reduce morbidity from CS; and aspects of organisation and environment which affect CS rates.
The aim of this guideline is to offer best practice advice on the care of people in the reproductive age group who perceive that they have problems in conceiving. Between 1998 and 2000, the Royal College of Obstetricians and Gynaecologists (RCOG) published three guidelines on the management of infertility that covered, respectively, initial investigation and management, management in secondary care and management in tertiary care. This guideline is based on those RCOG guidelines and takes into account a new review of the research evidence; it also covers the diagnostic, medical and surgical management of people throughout all stages of their care in primary-, secondary- and tertiary-care settings.
The use of bariatric surgery for treating severe obesity has increased dramatically over the past 10 years; about half of patients who undergo these procedures are women of reproductive age. This report was commissioned to measure the incidence of bariatric surgery in this population and review the evidence on the impact of bariatric surgery on fertility and subsequent pregnancy.
The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on outcomes of gestational weight gain and their confounders and effect modifiers, outcomes of weight gain within or outside the 1990 Institute of Medicine (IOM) guidelines, risks and benefits of weight gain recommendations, and anthropometric measures of weight gain.
“Don’t worry – the weight will just drop off quickly when you’re breastfeeding!” “Be careful – I never lost the weight after my second baby.” “Eat anything you want – you’re eating for two!” As with so many issues around pregnancy, it can seem as though everyone has an opinion about weight gain. It can be hard to find your way through all the competing advice. And comparing yourself to the magazine photos of movie stars in bikinis a few weeks after giving birth does not necessarily make real-life motherhood for the average woman any easier, either.
Many women who have asthma find that it actually improves in early pregnancy, or at least stays the same. But for about 1 in 3 women, the changes of pregnancy will make their asthma worse. Towards the end of pregnancy it often becomes increasingly difficult to stay physically active. Carrying the extra weight around can even make women who do not have asthma get out of breath. Many are unable to sleep properly, feel tired and exhausted. This does not make pregnancy any easier.
Using inhaled corticosteroids to control mild or moderate asthma in pregnancy can prevent asthma attacks and being hospitalised for asthma attacks in pregnancy. Inhaled budesonide has been tested particularly well in pregnancy and probably does not harm the baby.
Smoking during pregnancy increases the risk of the mother having complications during pregnancy and the baby being born too small (with low birthweight) and too early (prematurely, before 37 weeks). Low birthweight has been associated with coronary heart disease, type 2 diabetes, and being overweight in adulthood. Tobacco smoking also has serious long‐term health risks for both the women and their babies. Tobacco smoking during pregnancy is relatively common, although the trend is toward becoming less frequent in high‐income countries and more so in low to middle‐income countries. Many mothers find it hard to stop or reduce smoking during pregnancy even knowing the benefits of doing so as the nicotine in tobacco is very addictive. Smoking in pregnancy is also strongly associated with poverty, low levels of education, poor social support, depression and psychological illness.
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