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

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VA/DoD Clinical Practice Guideline For Pregnancy Management ALGORITHM Algorithm and Annotations Page - 11
VA/DoD Clinical Practice Guideline For Pregnancy Management A0. Organization of Prenatal Care BACKGROUND Goal-oriented visits can be provided during individual encounters with OB providers, or can be accomplished in a group setting. Recommendations for reduced visit prenatal care have been instituted at some healthcare facilities. This first DoD/VA Clinical Practice Guideline for the Management of Uncomplicated Pregnancy was implemented in 2003. One of the key components of the clinical practice guideline was changing from the traditional intervalbased visit template (every four weeks in the first and second trimesters) towards a system in which an antenatal visit is planned for a specific gestational age, with each visit having specific well-defined goals and objectives. Group prenatal care has been implemented in many clinical practices in the United States and abroad. Centering Pregnancy® is a group model of prenatal care which provides care in a group setting, integrating assessment support and education at each visit. Studies have shown group prenatal care results in equal or improved perinatal outcomes with no added cost. Level of care settings: Throughout this guideline, the term Routine Prenatal Care refers to prenatal care generally provided to pregnant women by Family Medicine Physicians, Women’s Health Nurse Practitioners, Certified Nurse-Midwives or Obstetrician/Gynecologists. The term Advanced Prenatal Care generally refers to care provided to women with complicated pregnancies provided by Obstetrician/Gynecologists and/or Maternal-Fetal Medicine specialists. Routine Prenatal Care Providers Individuals qualified to provide routine obstetric care include Family Practice Physicians, Certified Nurse- Midwives, Women’s Health Nurse Practitioners, and Obstetrician/Gynecologists. These providers may have varied experience in providing more advanced prenatal care. Advanced Prenatal Care Providers Obstetrician-Gynecologist: physician qualified by training and experience to manage complicated pregnancies by virtue of having completed four years of Obstetrics and Gynecology residency training and maintaining currency in the profession. Maternal-Fetal Medicine (MFM) Specialist: physician who has completed two to three years of Maternal-Fetal Medicine fellowship after completing four years of Obstetrics and Gynecology residency training. Fellowship training provides additional education and practical experience to gain special competence in managing various obstetrical, medical, and surgical complications of pregnancy. MFM sub-specialists function in collaboration with Family Medicine physicians, Women’s Health Nurse Practitioners, Certified Nurse-Midwives and Obstetricians. The relationship and referral patterns between Obstetrician-Gynecologists and MFM specialists will depend on the acuity of the patient’s condition and local circumstances. RECOMMENDATIONS 1. Goal-oriented prenatal care system can be delivered to all pregnant women. [B] 2. Education should be a central component of prenatal care for all pregnant women. [B] 3. Group model of prenatal care, such as the Centering Pregnancy® model, is an acceptable alternative to individual provider appointments. [A] DISCUSSION A systematic review published in the Cochrane database concluded that a reduction in the number of antenatal visits with an increased emphasis on the content with regard to services offered at each of the visits could be implemented without an increase in adverse perinatal outcomes (Villar et al., 2001). Partridge & Holman (2005) conducted a study to determine the effects of a reduced number of antepartum visits (as recommended by the 2003 VA/DoD Algorithm and Annotations Page - 12
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