Scope: antenatal care
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
SCOPE1 Guideline title
Antenatal care: routine antenatal care
1.1 Short title
a) The National Institute for Clinical Excellence ('NICE' or 'the Institute') has commissioned the National Collaborating Centre for Women and Children's Health to develop a clinical guideline on routine antenatal care for use in the NHS in England and Wales. This follows referral of the topic by the Department of Health and Welsh Assembly Government (see Appendix). The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.
b) The Institute's clinical guidelines will support the implementation of National Service Frameworks (NSFs) in those aspects of care where a Framework has been published. The statements in each NSF reflect the evidence that was used at the time the Framework was prepared. The clinical practice guidelines and technology appraisals published by the Institute after an NSF has been issued will have the effect of updating the Framework.
3 Clinical need for the guideline
a) The Changing Childbirth report explicitly confirmed that women should be the focus of maternity care. Care during pregnancy should enable a woman to make informed decisions, based on her needs, having discussed matters fully with the professionals involved.
b) Reviews of women's views on antenatal care suggest that key aspects of care valued by women are respect, competence, communication, support and convenience.
c) Current models of antenatal care originated in the early decades of the twentieth century. The pattern of visits recommended at that time (monthly until 30 weeks, then fortnightly to 36 weeks and then weekly until delivery) is still recognisable today. The content of antenatal care visits has been described as more ritualistic than rational.
d) One aspect of antenatal care is screening. Both the individual components and composite package of antenatal care should conform to the criteria for a successful screening programme, namely that:
Many new screening technologies have been introduced into antenatal care without thorough evaluation of their effectiveness.
4 The guideline
a) The guideline development process is described in detail in three booklets that are available from the NICE website (see 'Further information'). The Guideline Development Process - Information for Stakeholders describes how organisations can become involved in the development of a guideline.
b) This document is the scope. It defines exactly what this guideline will (and will not) examine, and what the guideline developers will consider. The scope is based on the referral from the Department of Health and Welsh Assembly Government (see Appendix).
c) The areas that will be addressed by the guideline are described in the following sections.
4.1.1 Groups that will be covered
a) The guideline will offer best practice advice on the following
(i) Best practice for baseline care of all pregnancies.
(ii) Comprehensive advice on the antenatal care of the healthy woman with an uncomplicated singleton pregnancy including those planning a homebirth, but the guideline will not address the specific intrapartum needs related to homebirth.
4.1.2 Healthcare setting
a) The guideline will cover the care received from primary and secondary healthcare professionals who have direct contact with and make decisions concerning routine antenatal care.
4.1.3 Clinical management
a) Organisation of antenatal care, taking into account the needs and choices of women, including:
(i) guidance on antenatal visits:
(ii) documentation of care
(iii) continuity of care and carer.
b) Antenatal screening including risk-factor assessment (for example, use of structured questionnaire), testing (for example, scan for congenital anomaly, HIV testing), clinical examination (for example, assessment of fetal growth). The guideline will advise on appropriate counselling and support pre- and post-screening.
c) The guideline will include educational aspects of antenatal care that are relevant to the antenatal health of the woman. This will include information and advice about:
(i) the normal physiological processes taking place, how the woman can contribute to her own and the baby's good health and well-being and minimize exposure to risks (for example, diet, exercise, alcohol and drug consumption, sexual activity and smoking cessation)
(ii) the management of common ailments
(iii) occupational risk factors in pregnancy.
d) The guideline will consider those communication issues that influence the ability of women to make informed decisions, based on their needs, having discussed matters fully with the healthcare professionals involved.
e) The guideline will offer advice on the optimal methods for providing antenatal education.
f) The guideline will address clinical aspects of antenatal care, including management of:
(i) breech presentation at term
(ii) pregnancy beyond 41 weeks gestation.
g) The investigation and management of complications arising in pregnancy are not included (for example, pre-eclampsia, fetal anomalies, multiple pregnancies).
h) The guideline will not address any aspect of intrapartum and postpartum care and therefore will exclude advice on birth or parenthood.
i) Advice on treatment options will be based on the best evidence available to the development group. When referring to pharmacological treatments, the guideline will normally recommend use within the licensed indications. Exceptionally, and only where the evidence supports it, the guideline may recommend use outside the licensed indications.
j) The guideline assumes that prescribers will use the Summary of Product Characteristics to inform their prescribing decisions for individual patients.
4.2 Audit support within guideline
The guideline will include review criteria and advice for audit.
This is the final version of the scope.
The development of the guideline recommendations will begin in May 2002.
5 Further information
Information on the guideline development process is provided in:
These booklets are available as PDF files from the NICE website (www.nice.org.uk). Information on the progress of the guideline will also be available from the website.
Appendix - Referral from the Department of Health and Welsh Assembly Government
The Department of Health and Welsh Assembly Government asked the Institute:
"to develop clinical and service guidelines for the NHS in England and Wales for the delivery of routine antenatal care for all women including the number and timing of antenatal visits required and evidence based justification for the scope and content of each. This work should include the antenatal care needs of those planning a home birth. The guideline should draw upon the evidence based recommendations of the antenatal subgroup of the National Screening Committee."
This page was last updated: 30 March 2010