WHO recommendations on antenatal care for a positive pregnancy experience

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espectively. Any concern about the validity of any recommendation will be promptly communicated via the interactive website for the guideline, 9 and plans will be made to update the recommendation, as needed. Two years after publication and dissemination of the guideline, an online survey will be conducted through <strong>WHO</strong> regional and country offices and through selected respondents of other user groups (e.g. professional societies, NGOs) to gauge the status and extent of in-country utilization and adaptation, and whether any <strong>recommendations</strong> in the guideline have been implemented or influenced policy decisions. This survey will also help in gathering feedback relevant to future modifications. Requests for additional guidance may also be received from <strong>WHO</strong> Member States. Stakeholders can address suggestions for additional questions for inclusion in the updated version of the guideline to the <strong>WHO</strong> Department of RHR by email (reproductivehealth@ who.int). All technical products developed during the process of developing this guideline – including full reports of systematic reviews, corresponding search strategies and dates of searches, Cochrane Review Manager (RevMan) 10 files customized for priority outcomes, and the basis for quality rating of outcomes within the GRADE process – will be archived in the departmental shared folder for future reference and use. Where there are concerns about the validity of a particular recommendation based on new evidence, the systematic review addressing the primary question will be updated. To update the review, the search strategy used for the initial review will be applied, possibly by the same systematic review team or another team if the initial review team is no longer available. Any new questions identified following the scoping exercise at the end of five years will undergo a similar process of evidence retrieval, synthesis and grading in accordance with the <strong>WHO</strong> standards for guideline development. <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience As the guideline nears the end of the proposed five-year validity period, the responsible technical officer (or another designated <strong>WHO</strong> staff person), in conjunction with the <strong>WHO</strong> Steering Group, will assess the currency of the <strong>recommendations</strong> and the need for new guidance on the topic. This will be achieved by performing a scoping exercise among technical experts, health professionals, researchers and service users to identify controversial or priority areas where further evidence-based guidance may be needed. 9 Available at: www.who.int/reproductivehealth/publications/ maternal_perinatal_health/anc-positive-pregnancy-experience/ en/ The guideline development process exposed several knowledge gaps related to antenatal screening of GDM, syphilis and haemoglobinopathies. <strong>WHO</strong> aims to develop further guidance around these topics so that the appropriate <strong>recommendations</strong> can be included in updated ANC guidance. In addition, future updates will aim to include more <strong>recommendations</strong> on how to improve ANC utilization, quality and delivery, which will be informed by new <strong>WHO</strong> guidance on improving the quality of care throughout the antenatal, intrapartum and postnatal continuum. 10 For further information, see: http://www.cochrane.org/revman 122
References 1. Office of the United Nations High Commissioner for Human Rights (OHCHR). Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality. Human Rights Council, twentieth session. New York (NY): United Nations General Assembly; 2012 (A/ HRC/21/22; http://www2.ohchr.org/english/ issues/women/docs/A.HRC.21.22_en.pdf, accessed 28 September 2016). 2. Tunçalp Ö, Were WM, MacLennan C, Oladapo OT, Gülmezoglu AM, Bahl R et al. Quality of care for pregnant women and newborns-the <strong>WHO</strong> vision. BJOG. 2015;122(8):1045–9. doi:10.1111/1471-0528.13451. 3. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A et al.; United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462–74. doi:10.1016/ S0140-6736(15)00838-7. 4. Maternal mortality. Fact sheet No. 348; Geneva: World Health Organization; 2014 (http://www. who.int/mediacentre/factsheets/fs348/en/ index.html, accessed 22 June 2014). 5. Blencowe H, Cousens S, Bianchi Jassir F, Chou D, Mathers C et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet. 2016;4(2):e98–108. doi:10.1016/S2214- 109X(15)00275-2. 6. Campbell OMR, Graham WJ; The Lancet Maternal Survival Series Steering Group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–99. 7. Fisk NM, McKee M, Atun, R. Relative and absolute addressability of global disease burden in maternal and perinatal health by investment in R&D. Trop Med Int Health. 2011;16(6):662-8. 8. Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001;15(Suppl 1):1–42. 9. Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z et al. Moving beyond essential interventions for reduction of maternal mortality (the <strong>WHO</strong> Multi-country Survey on Maternal and Newborn Health): a crosssectional study. Lancet. 2013;381(9879):1747– 55. doi:10.1016/S0140-6736(13)60686-8. 10. Integrated Management of Pregnancy and Childbirth (IMPAC). In: Maternal, newborn, child and adolescent health [<strong>WHO</strong> web page]. Geneva: World Health Organization (http://www.who.int/maternal_child_ adolescent/topics/maternal/impac/en/, accessed 17 October 2016). 11. Lincetto O, Mothebesoane-Anoh, Gomez P, Munjanja S. Chapter 2: Antenatal care. In: Lawn J, Kerber K, editors. Opportunities for Africa’s Newborns: practical data, policy and programmatic support for newborn care in Africa. Geneva: World Health Organization; 2006: 51–62 (http://www.who.int/pmnch/ media/publications/aonsectionIII_2.pdf, accessed 6 October 2016). 12. <strong>WHO</strong> antenatal care randomized trial: manual for the implementation of the new model. Geneva: World Health Organization; 2002 (http://www.who.int/reproductivehealth/ publications/maternal_perinatal_health/ RHR_01_30/en/, accessed 6 October 2016). 13. Downe S, Finlayson K, Tunçalp Ö, Gülmezoglu AM. What matters to women: a scoping review to identify the processes and outcomes of antenatal care provision that References 123
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Funding was provided for this guide
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Evaluation (GRADE) and Confidence i
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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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a list of ANC outcomes was prioriti
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content experts among the GDG membe
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Summary of evidence and considerati
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Equity Effective interventions to i
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only a quarter of the planned sampl
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on screening, please refer to the 2
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