Antenatal Care

National Collaborating Centre for Women's and Children's Health (UK)

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January 2019: Recommendation 1.8.8.1 on screening for German measles (rubella) has been withdrawn by NICE as this is no longer offered by the NHS. December 2018: Recommendations 1.3.9.1 -1.3.9.3 have been stood down and replaced with a link to up-to-date advice from the UK Chief Medical Officer. January 2017: A footnote was added to recommendation 1.6.2.2 linking to the NICE diagnostics guidance on high-throughput non-invasive prenatal testing for fetal RHD genotype (DG25). March 2016: Recommendations 1.9.1.1 -1.9.1.3 have been deleted as the guideline they were taken from has since been updated. For guidance on assessing risk of gestational diabetes, see the section on risk assessment in the NICE guideline on diabetes in pregnancy. December 2014: Recommendations 1.5.6.1 to 1.5.6.4 were replaced by recommendations in the NICE guideline on antenatal and postnatal mental health. November 2014: Recommendation 1.3.2.4 was updated to take into account NICE's guideline on vitamin D: increasing supplement use among at-risk groups. June 2010: The recommendations about smoking in pregnancy in section 1.3.10 of this guideline have been further developed in how to stop smoking in pregnancy and following childbirth NICE guideline PH26. We have removed the following recommendation from the antenatal care guideline, as well as the quick reference guide and information for the public: 1.3.10.7 Women who are unable to quit smoking during pregnancy should be encouraged to reduce smoking.

January 2019: Recommendation 1.8.8.1 on screening for German measles (rubella) has been withdrawn by NICE as this is no longer offered by the NHS. December 2018: Recommendations 1.3.9.1 -1.3.9.3 have been stood down and replaced with a link to up-to-date advice from the UK Chief Medical Officer. January 2017: A footnote was added to recommendation 1.6.2.2 linking to the NICE diagnostics guidance on high-throughput non-invasive prenatal testing for fetal RHD genotype (DG25). March 2016: Recommendations 1.9.1.1 -1.9.1.3 have been deleted as the guideline they were taken from has since been updated. For guidance on assessing risk of gestational diabetes, see the section on risk assessment in the NICE guideline on diabetes in pregnancy. December 2014: Recommendations 1.5.6.1 to 1.5.6.4 were replaced by recommendations in the NICE guideline on antenatal and postnatal mental health. November 2014: Recommendation 1.3.2.4 was updated to take into account NICE's guideline on vitamin D: increasing supplement use among at-risk groups. June 2010: The recommendations about smoking in pregnancy in section 1.3.10 of this guideline have been further developed in how to stop smoking in pregnancy and following childbirth NICE guideline PH26. We have removed the following recommendation from the antenatal care guideline, as well as the quick reference guide and information for the public: 1.3.10.7 Women who are unable to quit smoking during pregnancy should be encouraged to reduce smoking.

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Antenatal Care

Routine Care for the Healthy Pregnant Woman

NICE Clinical Guidelines, No. 62

National Collaborating Centre for Women's and Children's Health (UK).

London: RCOG Press; 2008 Mar.

ISBN-13: 978-1-904752-46-2

Excerpt

The original antenatal care guideline was published by NICE in 2003. Since then a number of important pieces of evidence have become available, particularly concerning gestational diabetes, haemoglobinopathy and ultrasound, so that the update was initiated. This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the ‘antenatal assessment tool’), information giving to women, lifestyle (vitamin D supplementation, alcohol consumption), screening for the baby (use of ultrasound for gestational age assessment and screening for fetal abnormalities, methods for determining normal fetal growth, placenta praevia), and screening for the mother (haemoglobinopathy screening, gestational diabetes, pre-eclampsia and preterm labour, chlamydia).

This is a partial update of the 2003 guideline.

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

Corrections to the full version of Antenatal Care (clinical guideline 62) published in March 2008

Grand multiparity was defined as ‘more than six pregnancies’ in this guideline. However, as the relevant evidence base was discussed in the Intrapartum Care guideline (clinical guideline 55, published September 2007) and was there defined as ‘four or more pregnancies’, the definition in the Antenatal Care guideline needs to be consistent. There are two places where this needs to be corrected.
Page 3, line 9
– grand multiparity (parity four or more)
Page 28 (page 9 of the reproduced care pathway from the Quick Reference Guide)
• grand multiparity (parity four or more)
The separate correction below was done in June 2008 and is repeated here for completeness.
In Section 5.12.1 Alcohol consumption in pregnancy, the GDG interpretation of evidence contains an error regarding the amount of alcohol that constitutes an episode of binge drinking. The correction is indicated in bold text in the extract below:
Page 98, last paragraph
There is limited poor-quality evidence that binge drinking, as defined by drinking 5 or more standard drinks in a single episode, may be associated with neurodevelopmental harm to the baby.
The corrected PDF file of the full guideline has been placed on the NICE website at www.nice.org.uk/CG062. Copies of the book identified as ‘revised reprint June 2008 (page 98), further revised reprint June 2009 (pages 3 and 28)’ on the copyright page are correct; all earlier printed copies should be manually amended with the correction indicated above. None of the recommendations in the guideline are affected.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK51886PMID: 21370514

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National Collaborating Centre for Women's and Children's Health (UK). Antenatal Care: Routine Care for the Healthy Pregnant Woman. London: RCOG Press; 2008 Mar. (NICE Clinical Guidelines, No. 62.)
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