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Antenatal care Implementing NICE guidance 2008 NICE clinical guideline 62.

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Presentation on theme: "Antenatal care Implementing NICE guidance 2008 NICE clinical guideline 62."— Presentation transcript:

1 Antenatal care Implementing NICE guidance 2008 NICE clinical guideline 62

2 What this presentation covers Updated recommendations Key priorities for implementation Costs and savings Discussion Find out more

3 Updated guidance This guideline replaces Antenatal care: Routine care for the healthy pregnant woman (NICE clinical guideline 6, 2003)

4 Updated recommendation; alcohol consumption Advise women to avoid alcohol in first 3 months of Pregnancy if possible If women choose to drink alcohol they should be advised to drink no more than 1 to 2 UK units once or twice a week Women should be informed that getting drunk or binge drinking during pregnancy may be harmful This advice is consistent with the advice issued in 2007 by the UK Chief Medical Officers

5 Key priorities for implementation Providing antenatal information Lifestyle considerations (vitamin D) Screening for haematological conditions Screening for fetal anomalies Screening for clinical conditions (gestational diabetes)

6 Offer information based on the current available evidence: –At first contact –At the booking appointment (ideally by 10 weeks) –Before or at 36 weeks –At 38 weeks Support women to make informed decisions relating to care pathway Providing antenatal information

7 Lifestyle considerations (vitamin D) At the booking appointment inform all women: of the need for adequate vitamin D stores during pregnancy and whilst breastfeeding that taking 10 mcg daily, as found in the Healthy Start multivitamin, can help achieve adequate stores Enquire whether women at greatest risk of deficiency are following the advice

8 Screening for haemoglobinopathies Screen all women for sickle cell diseases and thalassaemias (ideally by 10 weeks) The type of screening depends upon the prevalence and can be carried out in primary or secondary care - high prevalence: laboratory screening - low prevalence: initial screening with Family Origins Questionnaire

9 Screening for fetal anomalies Screen for Downs syndrome using: -the combined test between 11 weeks 0 days and 13 weeks 6 days -a serum screening test (triple or quadruple test) between 15 weeks 0 days and 20 weeks 0 days Participate in regional congenital anomaly registers and/or UK National Screening Committee-approved audit systems

10 Screening for clinical conditions At the booking appointment screen for risk factors associated with gestational diabetes Offer testing for gestational diabetes if any one risk factor identified

11 Costs and savings per 100,000 population Recommendations with significant resource impact (+/- ) Costs/savings (£ in first year) Screening for fetal anomalies12,700 Screening for Downs syndrome6,500 Screening and testing for gestational diabetes2,900 Treatment of gestational diabetes1,500 Avoidance of neonatal care for babies of women with diabetes– 2,300 Estimated net cost of implementation21,300 This slide includes Diabetes in Pregnancy costs and savings

12 For discussion What is our current advice regarding vitamin D supplementation? How can we reach the at risk groups? How can we ensure current referral patterns allow for early screening for haematological conditions? Who is best placed to offer this test? What changes will we need to make to ensure that we are screening all women at booking for gestational diabetes?

13 Find out more Visit for: Other guideline formats Costing report and template Audit support Implementation advice

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