Recommendations from NICE should help GPs provide evidence-based care for pregnant women, says Dr Peter Saul

The recent NICE guideline Antenatal care: routine care for the healthy pregnant woman does more than outline a care pathway, it offers a comprehensive guide to virtually every aspect of ‘normal’ antenatal care.

The guideline’s purpose is to ensure that antenatal services offer an evidence-based, patient-focused and logical path through pregnancy. The pattern of care that it defines looks set to replace some of the traditional, more haphazard, ways of working.

It’s pleasing to see a reduction in the number of recommended routine antenatal care appointments, to around 10 for nulliparous women and 7 for parous women, and the abandonment of such measures as routine iron administration and screening for gestational diabetes.

However, talking to some of the women attending the clinic at our practice, I detect a clear need for some to attend more frequently for reassurance and because of social factors. I can imagine many of the women in our antenatal clinic being anxious about the ‘gap’ in visits between 16 and 25 weeks. Patients’ wishes will have to be taken into account when implementing the guideline.

One change that many women will welcome is more clarity regarding ultrasound scanning. In my area and many others routine scans are done at 18 weeks, creating demand by women for earlier checks, particularly when their dates are in doubt. The guideline’s emphasis on an additional early scan will help address this need but will have significant workload implications for hospitals.

Implementing the guideline’s recommendations on fetal screening will similarly stretch resources. Our local trust offers a ‘double test’ for Down’s syndrome screening, but the guideline indicates that this is not sufficiently accurate and recommends tests such as the ‘triple test’ now and a move to even more accurate testing by April 2007.

Effective midwives and doctors already ensure that communication with pregnant women is good. This guideline rightly emphasises the importance of this and offers pointers to achieving it.

The need for written information that can be easily understood by the patient is highlighted. I hope that the literature we already give out goes at least some way to meeting this need.

There is a useful version of the guideline for patients, which gives a pretty comprehensive outline of antenatal (but not intrapartum or postnatal) care and some of the common problems that arise. It is just 39 pages long in large print and clearly lists what should happen and when.

The guideline has prompted a review of the current antenatal care in our practice. There will have to be changes, led by our local trust’s maternity team, but GPs will need to be closely involved. The changes are likely to be echoed in practices across the country.

Antenatal care: routine care for the healthy pregnant woman – Clinical guideline 6 can be downloaded from the NICE website:

Guidelines in Practice, November 2003, Volume 6(11)
© 2003 MGP Ltd
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