• Michigan Quality Improvement Consortium. Routine prenatal and postnatal care. Southfield (MI): Michigan Quality Improvement Consortium; 2006 Jul. 1 p.

This is the current release of the guideline.

Pregnancy and post partum

Evaluation
Prevention
Screening

Family Practice
Internal Medicine
Obstetrics and Gynecology
Preventive Medicine

Advanced Practice Nurses
Health Plans
Physician Assistants
Physicians

• To achieve significant, measurable improvements in the management of routine prenatal and postnatal care through the development and implementation of common evidence-based clinical practice guidelines
• To design concise guidelines that are focused on key  management components of routine prenatal and postnatal care to improve outcomes

• Pregnant women
• Post partum women up to 4 to 6 weeks after delivery

Routine prenatal and postnatal care  including:

1. Social and medical history
2. Patient assessment (e.g., dental and nutritional health, physical and sexual activity, alcohol and drug abuse, tobacco use, genetic risk factors, medications)
3. Patient education
4. Physical exam including pelvic exam
5. Fundal height, weeks gestation
6. Blood pressure, weight, body mass index (BMI)
7. Laboratory tests (e.g., routine urinalysis, culture, urine for glucose and albumin, Rh type, blood type, antibody screen, hemoglobin and hematocrit, Pap smear, maternal serum alpha fetoprotein, group B strep cultures [vaginal and rectal])
8. Fetal position and fetal heart tones
9. Human immunodeficiency virus (HIV) counseling and testing
10. Screening for sexually transmitted diseases (STD),  hepatitis B, rubella, and gestational diabetes
11. Influenza vaccine
12. Folic acid

Not stated

Searches of Electronic Databases

The Michigan Quality Improvement Consortium (MQIC) project leader conducts a search of current literature in support of the guideline topic. Computer database searches are used to identify published studies and existing protocols and/or clinical practice guidelines on the selected topic. A database such as MEDLINE and two to three other databases are used.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence for the Most Significant Recommendations

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

Review

Not stated

Expert Consensus

Using the health plan guideline summaries and information obtained from the literature search, the Michigan Quality Improvement Consortium (MQIC) director and/or project leader prepare a draft guideline for review by the MQIC Medical Directors.

The draft guideline and health plan guideline summaries are distributed to the MQIC Medical Directors for review and discussion at their next committee meeting.

The review/revision cycle may be conducted over several meetings before consensus is reached. Each version of the draft guideline is distributed to the MQIC Medical Directors, Measurement, and Implementation Committee members for review and comments. All feedback received is distributed to the entire membership.

Once the MQIC Medical Directors achieve consensus on the draft guideline, it is considered approved for external distribution to practitioners with review and comments requested.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review

Once the Michigan Quality Improvement Consortium (MQIC) Medical Directors achieve consensus on the draft guideline, it is considered approved for external distribution to practitioners with review and comments requested.

The MQIC director also forwards the approved guideline draft to presidents of the appropriate state medical specialty societies for their input. All feedback received from external reviews is presented for discussion at the next MQIC Medical Directors Committee meeting. In addition, physicians are invited to attend the committee meeting to present their comments.

The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

Routine Prenatal and Postnatal Care

¹ Education and counseling for prevention of unintended pregnancy

² Arrange follow-up to screen for non-gestational diabetes six weeks after delivery and annually thereafter

Definitions:

Levels of Evidence for the Most Significant Recommendation

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

None provided

Through a collaborative approach to developing and implementing common clinical practice guidelines and performance measures for routine prenatal and postnatal care, Michigan health plans will achieve consistent delivery of evidence-based services and better health outcomes. This approach also will augment the practice environment for physicians by reducing the administrative burdens imposed by compliance with diverse health plan guidelines and associated requirements.

Not stated

This guideline lists standard pregnancy management steps. Individual patient considerations and advances in medical science may supersede or modify these recommendations.

When consensus is reached on a final version of the guideline, a statewide mailing of the approved guideline is completed. The guideline is distributed to physicians in the following medical specialties:

• Family Practice
• General Practice
• Internal Medicine
• Other Specialists for which the guideline is applicable (e.g., endocrinologists, allergists, pediatricians, cardiologists)

Staying Healthy

Effectiveness
Patient-centeredness

• Michigan Quality Improvement Consortium. Routine prenatal and postnatal care. Southfield (MI): Michigan Quality Improvement Consortium; 2006 Jul. 1 p.

2006 Jul

Michigan Quality Improvement Consortium - Professional Association

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Director's Committee

Physician representatives from participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health and Michigan Peer Review Organization

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on October 16, 2006. The information was verified by the guideline developer on November 3, 2006.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.