Clinical Practice Guidelines Antenatal Care — Module II
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ContentsForeword 3 Contents 4 Summary 5 Summary of recommendations 6 Summary of recommendations and practice points from Module I 12 Introduction 19 Part A — Optimising antenatal care 21 1Principles of care 21 References 21 2Antenatal care for migrant and refugee women 22 2.1Background to culturally safe antenatal care 22 2.2Providing woman-centred care 23 2.3Service delivery issues for migrant and refugee women 26 2.4Resources 26 2.5References 27 3Antenatal care for women with mental health disorders 28 3.1Identifying and managing mental health disorders during pregnancy 28 3.2Understanding the woman’s perspective 29 3.3Resources 30 3.4References 31
4.1Antenatal visits 32 4.2Resources 38 4.3References 39 4.4Preparing for pregnancy, childbirth and parenthood 40 4.5Resources 42 4.6References 43 4.7Preparing for breastfeeding 45 4.8Resources 49 4.9References 49 5Lifestyle considerations 52 5.1Nutrition 54 5.2Resources 58 5.3References 58 5.4Physical activity 61 5.5Resources 63 5.6References 63 5.7Sexual activity 66 5.8Resources 66 5.9References 67 5.10Travel 68 5.11Resources 70 5.12References 70
1.1Fetal development and anatomy 74 6.1Resources 76 6.2References 76 6.4Fetal growth and wellbeing 79 6.5Resources 82 6.6References 82 6.7Risk of pre-eclampsia 84 6.8Resources 88 6.9References 88 6.10Risk of preterm birth 92 6.11References 94 7Common conditions during pregnancy 97 7.1Reflux (heartburn) 98 7.2Resources 99 7.3References 99 7.5Haemorrhoids 101 7.6Resources 102 7.7References 102 7.8Varicose veins 103 7.9Resources 104 7.10References 104 7.11Pelvic girdle pain 105 7.12Resources 106 7.13References 106 7.14Carpal tunnel syndrome 108 7.15Resources 109 7.16References 109 8Maternal health screening 110 8.1Considerations before testing 111 8.2Anaemia 113 8.3Resources 116 8.4References 116 8.5Diabetes 118 8.6Resources 124 8.7References 124 8.8Haemoglobin disorders 128 8.9Resources 130 8.10References 130 8.11Gonorrhoea 132 8.12Resources 134 8.13References 134 9.1Trichomoniasis 136 9.2Resources 138 9.3References 138 9.4Group B streptococcus 140 9.5Resources 142 9.6References 142 9.7Toxoplasmosis 145 9.8Resources 146 9.9References 146 9.10Cytomegalovirus 149 9.11References 151 9.12Cervical abnormalities 153 9.13Resources 155 9.14References 155 9.15Thyroid dysfunction 157 9.16Resources 159 9.17References 159
10.1Fetal presentation 161 10.2Resources 164 10.3References 164 10.4Prolonged pregnancy 167 10.5Resources 169 10.6References 169
10.7Antenatal care for migrant and refugee women 171 Appendices 173 A Membership of the committees 173 B Terms of reference 174 10.8Expert Advisory Committee 174 C Administrative report 177 10.10Background 177 D Review of the evidence 185 10.11Process of the systematic literature reviews 185 E Economic analyses 209 10.12Ultrasound assessment of fetal anatomy 209 Acronyms and abbreviations 215 Glossary 218 10.13Methodological terms 219 List of tables Definition of grades of recommendations and practice points 6 Recommendations and practice points 6 Table 5.2: Recommended number of daily serves during pregnancy 55 Diabetes in pregnancy — one or more of the following criteria are met 122 Table C1: Key steps in the guideline development process 179 Table D1: Designations of levels of evidence according to type of research question 185 Table D2: Components of body of evidence considered when grading each recommendation 187
List of figures Figure E1: Estimated costs of screening program in Australia 211 Figure E2: Scenario testing — more and less conservative scenarios 211 SummaryAntenatal care is a routine part of pregnancy for most of the 298,000 women who give birth in Australia each year. Women receive antenatal care in community and hospital-based settings and see a range of health professionals. Effective models of antenatal care have a focus on the individual woman’s needs and preferences, collaboration and continuity of care. These national Clinical Practice Guidelines on Antenatal Care provide evidence-based recommendations to support high quality, safe antenatal care in all settings. This document is Module II of the Guidelines. Module I was published in March 2013. As outlined in Module I, effective antenatal care focuses on the individual woman’s needs and preferences, collaboration and continuity of care. Taking a woman-centred approach also ensures that a woman’s social, emotional, physical, psychological, spiritual and cultural needs and expectations are considered and respected. Throughout the pregnancy, women should be given information in an appropriate form to support them to make choices about their care. Within the diversity of women that make up the Australian population, some face greater disadvantage in terms of access to health services and may experience poorer outcomes. The broader context of a woman’s life should be taken into account in planning and providing antenatal care. Module I highlights specific approaches to antenatal care for a range of groups, with a focus on improving the experience of antenatal care for Aboriginal and Torres Strait Islander women. This Module outlines additional considerations for antenatal care for migrant and refugee women and for women with mental health disorders. Module I largely focuses on antenatal care in the first trimester. This Module provides guidance on core practices, lifestyle considerations, clinical assessments, common conditions and maternal health tests that are relevant throughout antenatal care for healthy pregnant women. This includes: providing information to support parents to prepare for the rest of pregnancy, childbirth and parenthood; promoting breastfeeding; assessing fetal wellbeing (eg offering a 18–20 week ultrasound scan, discussing fetal movements and assessing fetal growth); assessing the health of the woman, in particular factors indicating that additional care may be required (eg those at increased risk of preterm birth or pre-eclampsia); providing advice on symptoms that are common during pregnancy (eg reflux and haemorrhoids); assessing for any conditions that may affect the health of the woman or the unborn baby (eg anaemia, diabetes, sexually transmitted infections, mental health disorders); discussing health and wellbeing during pregnancy (eg nutrition, physical activity); and providing opportunities for women to raise any issues they wish to discuss. A planned schedule of antenatal visits should be agreed early in pregnancy, based on the individual woman’s needs. Assessment of a woman’s risk and any requirement for additional care continues throughout pregnancy. These Guidelines are not intended as a textbook of antenatal care. A process of prioritisation was used to decide which topics were relevant to the Australian context. While many of these topics involve clinical assessment and maternal health screening, the management of any conditions identified is not discussed. Health professionals are directed to appropriate resources where available. The Guidelines provide a reliable and standard reference for health professionals providing antenatal care. By providing a summary of the currently available evidence on many aspects of antenatal care, they aim to promote consistency of care and improve the experience and outcomes of antenatal care for all families.
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