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

VA/DoD Clinical Practice Guideline
For Pregnancy Management
returning to work before the eight-week time frame. As facilities switch to liquid-based cytology, new studies will
be needed to evaluate the number of false positives at six versus eight weeks postpartum to optimize visit timing.
The postpartum Pap smear is of value in identifying a significant yield of dysplasia. The sensitivity of the prenatal
Pap test may be less than desired. The rate of abnormal postpartum smears in pregnant women with normal prenatal
smears ranges from 2.8 (Londo et al., 1994) to over 5 percent (Weiss et al., 1989). These studies are challenged by a
smaller study by Jazayeri and colleagues, who found that in patients without risk factors for cervical intraepithelial
neoplasia and a normal Pap smear during pregnancy, there was no significant difference between their prenatal and
postpartum smears (Jazayeri et al., 1999).
Women with a history of GDM are at increased risk of developing diabetes. Some women will be diagnosed shortly
after pregnancy, suggesting they had pre-existing diabetes. Although the ADA advocates use of fasting blood
glucose determination, the oral GTT will more accurately identify those women with impaired glucose tolerance.
Unfortunately, the incidence of postpartum screening in women with GDM is poor.
There is no evidence to recommend for or against discussion of specific topics at the post partum visit. Topics to be
addressed at this visit are ultimately based on the discretion of the provider and the needs of the woman.
EVIDENCE TABLE
Recommendations Sources of Evidence LE QE SR
1 Postpartum visit at eight weeks Rarick & Tchabo, 1994 I Good B
2 Tests traditionally performed at this
visit include the cervical smear, pelvic
exam, and breast exam.
The Pap smear may be deferred in
women without a history of abnormal
Pap smears and whose Pap smear
remains current
Jazaveri et al., 1999
Londo et al., 1994
Weiss et al., 1989
II Fair B
3 Diabetes screening in women whose
pregnancies were complicated by
GDM
ACOG, 2001
Conway, 1999
II Fair B
LE = Level of Evidence; QE = Quality of Evidence; SR = Strength of Recommendation (See Appendix A)
Algorithm and Annotations Page - 25