WHO recommendations on antenatal care for a positive pregnancy experience

<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
B.2.3. Routine antenatal
cardiotocography (CTG)
• If routine antenatal CTG is
being conducted
• If being conducted, instruct
providers to omit this from
practice, due to lack of
evidence.
• N/A • N/A
B.2.4. Routine ultrasound scans • Health system level
– – Number and capacity of
ultrasound providers to act
as providers and trainers/
mentors
– – Number of functional
machines available and
geographic distribution
– – Regulations around
ultrasound use
– – Cadres – who can perform?
– – Available pre-service
education and other
certification
• Provider level
– – Training to do anatomy scan
or on referral
– – How to interpret results and
do counselling
• Health system level
• Health system level
(AIUM) guidelines f
– – Determine appropriate settings and timeline for introduction of ultrasound – – Transportation for women if services
are not sufficiently decentralized
– – Cadres with skills to provide quality
– – Obtain machines
services
– – Capacity-building plan • Facility level
• Provider level
– – Machines
– – Conduct or refer
– – Mechanism to review results and get
– – Document results
reports
– – Provide guidance on how to – – Service contracts for machines
estimate GA and delivery – – Surge protection
date (EDD), depending on – – Power supply
certainty of last menstrual – – Counselling skills
period (LMP) and estimated – – Security and environmental
GA at time of ultrasound, protection for costly machine
e.g. <strong>WHO</strong>’s Manual of
– – Space for machine
diagnostic ultrasound e and – – Ultrasound gel supply
the American Institute of – – Staff and supplies to keep equipment
Ultrasound in Medicine
clean
• Cost – of purchase, maintenance,
training, impact of shifting resources to
ultrasound from other key costs
• Local availability/feasibility of
service contracts to support machine
maintenance, especially in areas not
previously prioritized for ultrasound
market development
• Power supply – availability and stability
• Protection from power surges, which
can permanently damage machines
• Extreme fragility of ultrasound
transducers (one drop on a concrete
floor may necessitate purchase of a
new transducer, costing thousands of
dollars)
• Relative benefits compared to other
interventions
• Burden to mother
• Burden to providers and facility
• Creative, alternative models of service
delivery that do not burden women
with travel and related costs
• Feasibility studies in settings without
widely available ultrasonography
• Studies on quality of ultrasound
B.2.5. Routine Doppler
ultrasound
• If routine Doppler ultrasound is
being conducted
• If being conducted, instruct
providers to omit or consider in
the context of research
• N/A • Research context
e. Manual of diagnostic ultrasound, second edition. Geneva: World Health Organization; 2013 (http://www.who.int/medical_devices/publications/manual_ultrasound_pack1-2/en/, accessed 21 October 2016).
f. AIUM practice parameter for the performance of obstetric ultrasound examinations. Laurel (MD): American Institute of Ultrasound in Medicine (AIUM); 2013 (http://www.aium.org/resources/guidelines/
obstetric.pdf, accessed 21 October 2016).
148