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Antenatal care

Antenatal care. Implementing NICE guidance. Slide Set 2011 (2 nd Edition). NICE clinical guideline 62. What this presentation covers. Updated recommendations Key priorities for implementation Costs and savings Discussion NICE Maternity Pathway NHS Evidence Find out more .

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Antenatal care

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  1. Antenatal care Implementing NICE guidance Slide Set 2011 (2nd Edition) NICE clinical guideline 62

  2. What this presentation covers • Updated recommendations • Key priorities for implementation • Costs and savings • Discussion • NICE Maternity Pathway • NHS Evidence • Find out more

  3. Updated guidance This guideline replaced ‘Antenatal care: Routine care for the healthy pregnant woman’ (NICE clinical guideline 6, 2003)

  4. Updated recommendation; alcohol consumption • Advise women to avoid alcohol in first 3 months of pregnancy if possible • If women choose to drink alcohol they should be advised to drink no more than 1 to 2 UK units once or twice a week • Women should be informed that getting drunk or binge drinking during pregnancy may be harmful • This advice is consistent with the advice issued in 2007 by the UK Chief Medical Officers

  5. Updated recommendation:quitting smoking in pregnancy • This guideline was amended following the release of the NICE public health guidance PH26 “Quitting smoking in pregnancy and following childbirth”. • Reducing smoking is no longer recommended for pregnant women who are attempting to quit. • Women should be advised to stop smoking completely, rather than cutting down (NICE PH26)

  6. Key priorities for implementation • Providing antenatal information • Lifestyle considerations (vitamin D) • Screening for haematological conditions • Screening for fetal anomalies • Screening for clinical conditions (gestational diabetes)

  7. Providing antenatal information • Offer information based on the current available evidence: • At first contact • At the booking appointment (ideally by 10 weeks) • Before or at 36 weeks • At 38 weeks • Support women to make informed decisions relating to care pathway

  8. Lifestyle considerations (vitamin D) • At the booking appointment inform all women: • of the need for adequate vitamin D stores during pregnancy and whilst breastfeeding • that taking 10 mcg daily, as found in the Healthy Start multivitamin, can help achieve adequate stores • Enquire whether women at greatest risk of deficiency are following the advice

  9. Screening for haemoglobinopathies • Screen all women for sickle cell diseases and thalassaemias (ideally by 10 weeks) • The type of screeningdepends upon the prevalence and can be carried out in primary or secondary care - high prevalence: laboratory screening - low prevalence: initial screening with ‘Family Origins Questionnaire’

  10. Screening for fetal anomalies • Screen for Down’s syndrome using: • the ‘combined test’ between 11 weeks 0 days and 13 weeks 6 days • a serum screening test (triple or quadruple test) between 15 weeks 0 days and 20 weeks 0 days • Participate in regional congenital anomaly registers and/or UK National Screening Committee-approved audit systems

  11. Screening for clinical conditions • At the booking appointment screen for risk factors associated with gestational diabetes • Offer testing for gestational diabetes if any one risk factor identified

  12. Costs and savings per 100,000 population This slide includes Diabetes in Pregnancy costs and savings

  13. For discussion • What is our current advice regarding vitamin D supplementation? How can we reach the ‘at risk’ groups? • How can we ensure current referral patterns allow for early screening for haematological conditions? Who is best placed to offer this test? • What changes will we need to make to ensure that we are screening all women at booking for gestational diabetes?

  14. NICE Pathway • The NICE antenatal care pathway covers all routine care for pregnant women and entry into other pathways for additional care Click here to go to NICE Pathways website

  15. NHS Evidence Click here to go to the NHS Evidence website Visit NHS Evidence for the best available evidence on all aspects of maternity care

  16. Find out more • Visit www.nice.org.uk/guidance/CG62 for: • the guideline • ‘Understanding NICE guidance’ • costing report and template/costing statement • audit support

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