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 Implementation considerations for ANC guideline <strong>recommendations</strong> Need to know Need to do Need to have Consider A.10. a Restricting caffeine intake • Whether local women typically have caffeine in their diet • Counselling • Counselling skills • Time and space for counselling • Gender issues and cultural norms for and expectations of women • Task shifting B. Maternal and fetal assessment B.1. Maternal assessment B.1.1. Diagnosing anaemia • What method is in place to diagnose anaemia • What method is feasible to start with • How to interpret and manage • Collect specimens • Follow kit instructions • Maintain infection control standards • Capacity to conduct • Kits • Quality assurance/quality control (QA/QC) for any lab testing • Commodities for treatment • Switching to full blood count or haemoglobinometer method, if feasible B.1.2. Diagnosing asymptomatic bacteriuria (ASB) • What method is in to diagnose ASB • What method is feasible to start • How to interpret and manage • Collect specimens • Follow kit instructions • Maintain infection control standards • Capacity to conduct • Kits • QA/QC for any lab testing • Commodities for treatment • What levels of care are feasible for each type of test, with urine culture and sensitivity (C&S) being gold standard but dipstick sufficient in facilities without capacity B.1.3. Enquiry about intimate partner violence (IPV) • Local resources available to address IPV if identified during ANC • How to enquire if <strong>WHO</strong> minimum requirements are in place b • Country-level guidelines and policies • Ask about IPV • Counselling • Well trained providers on first-line response • Resources and referral mechanisms in place • Time to counsel • Sufficient confidential counselling space • Counselling skills • Forming linkages to supportive and social services if not already in place B.1.4. Diagnosing gestational diabetes mellitus (GDM) • National guidance/standard of care • Guidelines for management of abnormal results • Information on local context • Counselling and testing • Mechanisms and systems for testing and receiving results • Time and space to counsel • Counselling skills • Commodity management for oral glucose solution and testing supplies • QA/QC • Clinical algorithm • Reference existing guideline • Feasibility and acceptability of screening strategies a. Recommendations A.5–A.9 are not included because interventions that are not recommended are excluded from the implementation considerations table. b. Minimum requirements are: a protocol/standard operating procedure; training on how to ask about IPV, and on how to provide the minimum response or beyond; a private setting; confidentiality ensured; system for referral in place; and time to allow for appropriate disclosure. 146
Implementation considerations for ANC guideline <strong>recommendations</strong> Need to know Need to do Need to have Consider B.1.5. Screening for tobacco use • How to screen/enquire • Counselling • Counselling skills • Time to counsel • Gender issues and cultural norms for and expectations of women • Task shifting B.1.6. Screening for alcohol and substance abuse • Information on local context • Local norms and behaviours around these risks • Refer to the specific <strong>WHO</strong> guideline c • Counselling and testing • Time and space to counsel • Counselling skills • Referencing existing guideline • Cultural context and local norms, impact of gender • Impact of routine questioning in specific settings • Task shifting • Group-based counselling B.1.7. HIV testing • Retest women in high prevalence settings or in key high-risk groups • Counselling and testing • Commodities for testing • Time to counsel • Counselling skills • Linkage to treatment • Task shifting B.1.8. Tuberculosis (TB) screening • Population prevalence of TB • Refer to the specific <strong>WHO</strong> guidance d • Consider having TB clinics track pregnancy as a column in the register, to allow for better estimation of the local burden of TB in pregnancy. B.2. Fetal assessment B.2.1. Routine daily fetal movement (FM) counting • If routine daily FM counting is being advised • If ANC providers are advising daily FM counting in routine ANC counselling, instruct them to omit it, due to lack of evidence. • N/A • N/A B.2.2. Symphysis-fundal height (SFH) measurement • What methods are being used for fetal growth and gestational age (GA) assessment • Continue to include GA assessment and fetal growth assessment (by SFH or clinical palpation) in ANC contacts and documentation • N/A • No proven benefit to switching to fundal height measurement in settings where not currently in place. c. <strong>WHO</strong> guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/ bitstream/10665/107130/1/9789241548731_eng.pdf, accessed 28 September 2016). d. Systematic screening for active tuberculosis: principles and <strong>recommendations</strong> Geneva: World Health Organization; 2013 (http://apps.who.int/iris/bitstream/10665/84971/1/9789241548601_eng.pdf, accessed 28 September 2016). Annex 4: Implementation considerations 147
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WHO recomm
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WHO Library Catalo
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« To achieve the Every Woman Every
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Funding was provided for this guide
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WHO recomm
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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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are willing to be screened and test
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Women’s values A scoping review o
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C.4: Preventive anthelminthic treat
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C.5: Tetanus toxoid vaccination REC
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C.6: Intermittent preventive treatm
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D. Interventions for common physiol
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Values See “Women’s values” a
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D.4: Interventions for low back and
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Acceptability Qualitative evidence
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Additional considerations • nComp
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WHO recomm
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Senegal, Sri Lanka, Yemen and Zambi
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WHO recommendations on antenatal care for a positive pregnancy experience

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