Management of pregnancy - VA/DoD Clinical Practice Guidelines ...

VA/DoD Clinical Practice Guideline
For Pregnancy Management
Lack of Evidence – Consensus of Experts
Where existing literature was ambiguous or conflicting, or where scientific data were lacking on an issue,
recommendations were based on the clinical experience of the Working Group.
Algorithm Format
The goal in developing the guideline for management of UCP was to incorporate the information into a format
which would maximally facilitate clinical decision-making. The use of the algorithm format was chosen in
light of the evidence that such a format improves data collection, diagnostic and therapeutic decision-making
and changes patterns of resource use. However, few guidelines are published in such a format.
The algorithmic format allows the provider to follow a linear approach to critical information needed at the
major decision points in the clinical process, and includes:
• An ordered sequence of steps of care
• Recommended observations
• Decisions to be considered
• Actions to be taken
A clinical algorithm diagrams a guideline into a step-by-step decision tree. Standardized symbols are used to
display each step in the algorithm (Society for Medical Decision-Making Committee, 1992). Arrows connect
the numbered boxes indicating the order in which the steps should be followed.
Rounded rectangles represent a clinical state or condition.
Hexagons represent a decision point in the guideline, formulated as a
question that can be answered Yes or No. A horizontal arrow points to the
next step if the answer is YES. A vertical arrow continues to the next step
for a negative answer.
Rectangles represent an action in the process of care.
Ovals represent a link to another section within the guideline.
A letter within a box of an algorithm refers the reader to the corresponding annotation. The annotations
elaborate on the recommendations and statements that are found within each box of the algorithm. Included in
the annotations are brief discussions that provide the underlying rationale and specific evidence tables.
Annotations indicate whether each recommendation is based on scientific data or expert opinion. A complete
bibliography is included in the guideline.
REFERENCES
Agency for Health Care Policy and Research (AHCPR). Manual for conducting systematic review. Draft.
August 1996. Prepared by Steven H. Woolf.
Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D; Methods Work Group, Third
US Preventive Services Task Force Current methods of the U.S. Preventive Services Task Force: a
review of the process. Am J Prev Med 2001 Apr;20(3 Suppl):21-35.
Appendices - Page 115