Management of pregnancy - VA/DoD Clinical Practice Guidelines ...
Management of pregnancy - VA/DoD Clinical Practice Guidelines ...
Management of pregnancy - VA/DoD Clinical Practice Guidelines ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>VA</strong>/<strong>DoD</strong> <strong>Clinical</strong> <strong>Practice</strong> Guideline<br />
For Pregnancy <strong>Management</strong><br />
• Late entry counseling. This counseling should be provided to women presenting for prenatal care when the<br />
gestational age <strong>of</strong> her <strong>pregnancy</strong> limits options for screening strategies or diagnostic testing. The<br />
counseling should be based on the individual circumstances including the gestational age and patient<br />
desires.<br />
EVIDENCE TABLE<br />
Recommendations Sources <strong>of</strong> Evidence LE QE SR<br />
1 All women, regardless <strong>of</strong> age, should<br />
be <strong>of</strong>fered aneuploidy screening<br />
2 When discussing options with patients,<br />
providers should furnish information<br />
on detection and false positive rates,<br />
advantages and disadvantages <strong>of</strong> each<br />
testing method<br />
ACOG, 2007 III Fair B<br />
ACOG, 2007 III Fair B<br />
3 Unique benefits with each type <strong>of</strong><br />
intervention: individual counseling,<br />
group counseling sessions, and use <strong>of</strong><br />
decision aids and audiovisual<br />
presentation<br />
5 First-trimester screening can lead to a<br />
diagnosis <strong>of</strong> fetal aneuploidy much<br />
earlier<br />
6 Measurement <strong>of</strong> nuchal translucency<br />
alone is less effective for first-trimester<br />
screening than is the combined test<br />
(nuchal translucency measurement and<br />
biochemical markers)<br />
Hunter et al., 2005<br />
Fries et al., 2005<br />
ACOG, 2007<br />
Malone et al., 2003, 2005<br />
Wapner et al., 2003<br />
Wald et al., 2003<br />
Nicolaides et al., 2004<br />
Snijders et al., 2002<br />
I Fair B<br />
I Good A<br />
IIb Fair B<br />
7 Patients undergoing first-trimester<br />
screening for aneuploidy should be<br />
<strong>of</strong>fered maternal serum alpha<br />
fetoprotein (MSAFP) in the second<br />
trimester to screen for open neural tube<br />
defects<br />
Lennon et al., 1999<br />
Nicolaides et al., 1992<br />
II Fair B<br />
LE = Level <strong>of</strong> Evidence; QE = Quality <strong>of</strong> Evidence; SR = Strength <strong>of</strong> Recommendation (See Appendix A)<br />
Interventions Page - 75