WHO recommendations on antenatal care for a positive pregnancy experience

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<strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience Type of intervention Recommendation Type of recommendation Eight scheduled ANC contacts (weeks of gestation) 1 2 3 4 5 6 7 8 (12 weeks) (20 weeks) (26 weeks) (30 weeks) (34 weeks) (36 weeks) (38 weeks) (40 weeks) Human immunodeficiency virus (HIV) and syphilis B.1.7: In high prevalence settings, r provider-initiated testing and counselling (PITC) for HIV should be considered a routine component of the package of care for pregnant women in all antenatal care settings. In low-prevalence settings, PITC can be considered for pregnant women in antenatal care as a key component of the effort to eliminate mother-to-child transmission of HIV, and to integrate HIV testing with syphilis, viral or other key tests, as relevant to the setting, and to strengthen the underlying maternal and child health systems. s Recommended X Tuberculosis (TB) B.1.8: In settings where the tuberculosis (TB) prevalence in the Context-specific general population is 100/100 000 population or higher, systematic recommendation screening for active TB should be considered for pregnant women as part of antenatal care. t X Daily fetal movement counting B.2.1: Daily fetal movement counting, such as with “count-to-ten” kick charts, is only recommended in the context of rigorous research. Context-specific recommendation (research) Symphysis-fundal height (SFH) measurement B.2.2: Replacing abdominal palpation with symphysis-fundal height (SFH) measurement for the assessment of fetal growth is not recommended to improve perinatal outcomes. A change from what is usually practiced (abdominal palpation or SFH measurement) in a particular setting is not recommended. Context-specific recommendation X X X X X X X X Antenatal cardiotocography B.2.3: Routine antenatal cardiotocography u is not recommended for pregnant women to improve maternal and perinatal outcomes. Not recommended r. High-prevalence settings are defined in the 2015 <strong>WHO</strong> publication Consolidated guidelines on HIV testing services as settings with greater than 5% HIV prevalence in the population being tested (98). Low-prevalence settings are those with less than 5% HIV prevalence in the population being tested. In settings with a generalized or concentrated HIV epidemic, retesting of HIV-negative women should be performed in the third trimester because of the high risk of acquiring HIV infection during pregnancy; please refer to Recommendation B.1.7 for details. s. Adapted and integrated from the 2015 <strong>WHO</strong> publication Consolidated guidelines on HIV testing services (98). t. Adapted and integrated from the 2013 <strong>WHO</strong> publication Systematic screening for active tuberculosis: principles and <strong>recommendations</strong> (105). u. Cardiotocography (CTG) is a continuous recording of the fetal heart rate and uterine contractions obtained via an ultrasound transducer placed on the mother’s abdomen. 112
Type of intervention Recommendation Type of recommendation Eight scheduled ANC contacts (weeks of gestation) 1 2 3 4 5 6 7 8 (12 weeks) (20 weeks) (26 weeks) (30 weeks) (34 weeks) (36 weeks) (38 weeks) (40 weeks) Ultrasound scan B.2.4: One ultrasound scan before 24 weeks of gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience. Recommended X X Doppler ultrasound of fetal blood vessels B.2.5: Routine Doppler ultrasound examination is not recommended Not recommended for pregnant women to improve maternal and perinatal outcomes. v C. Preventive measures Antibiotics for asymptomatic bacteriuria (ASB) C.1: A seven-day antibiotic regimen is recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight. Recommended X X X Antibiotic prophylaxis to prevent recurrent urinary tract infections C.2: Antibiotic prophylaxis is only recommended to prevent recurrent urinary tract infections in pregnant women in the context of rigorous research. Context-specific recommendation (research) Antenatal anti-D immunoglobulin administration C.3: Antenatal prophylaxis with anti-D immunoglobulin in nonsensitized Rh-negative pregnant women at 28 and 34 weeks of gestation to prevent RhD alloimmunization is only recommended in the context of rigorous research. Context-specific recommendation (research) Preventive anthelminthic treatment C.4: In endemic areas w , preventive anthelminthic treatment is Context-specific recommended for pregnant women after the first trimester as part of recommendation worm infection reduction programmes. x X v. Doppler ultrasound technology evaluates umbilical artery (and other fetal arteries) waveforms to assess fetal well-being in the third trimester of pregnancy. w. Areas with greater than 20% prevalence of infection with any soil-transmitted helminths. x. Consistent with the 2016 <strong>WHO</strong> publication Guideline: preventive chemotherapy to control soil-transmitted helminth infections in high-risk groups (140). Chapter 4. Implementation of the ANC guideline and <strong>recommendations</strong> 113
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« To achieve the Every Woman Every
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Funding was provided for this guide
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Evaluation (GRADE) and Confidence i
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Zinc supplements Multiple micronutr
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Ultrasound scan Doppler ultrasound
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Task shifting components of antenat
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expect from ANC is to have a “pos
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2. Methods WHO <st
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a list of ANC outcomes was prioriti
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content experts among the GDG membe
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• nFeasibility: Feasibility is in
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are indicated by a footnote in the
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A. Nutritional interventions <stron
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A.1.2: Nutrition education on energ
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A.1.3: Energy and protein dietary s
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A.1.4: High-protein supplements REC
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Summary of evidence and considerati
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Equity Effective interventions to i
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A.7: Vitamin B6 (pyridoxine) supple
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only a quarter of the planned sampl
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A.10: Restricting caffeine intake R
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B. Maternal and fetal assessment B.
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to produce results than urine dipst
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B.1.4: Gestational diabetes mellitu
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B.1.6: Substance use RECOMMENDATION
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on screening, please refer to the 2
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Women’s values A scoping review o
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B.2.2: Symphysis-fundal height (SFH
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B.2.4: Ultrasound scan RECOMMENDATI
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WHO recommendations on antenatal care for a positive pregnancy experience

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