Clinical guidelines for postpartum women and infants in primary care–a systematic review

Abstract

BackgroundWhile many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care.MethodsPubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument.ResultsSix guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest.ConclusionsOnly one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.

Methodological quality of guidelines for management of Lyme neuroborreliosis

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Management of physical pain during induced second‐trimester medical abortions: a cross‐sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals

“…Moreover, only the author performed the quality assessments, implying a risk of bias. However, the AGREE II instrument has been shown to have adequate levels of validity and reliability , and previous studies indicate high interrater reliability when multiple assessors are used . This, combined with the fact that two separate instruments were used to assess methodological quality, strengthens the findings concerning poor quality.…”

Australian general practice registrars and their experience with postpartum consultations: A cross‐sectional analysis of prevalence and associations

“…Learning objectives in relation to postpartum care are supported by the RACGP's guidelines for preventative activities in general practice. However, these guidelines have been criticised as having a limited focus, and not providing a comprehensive approach to the mother‐infant dyad . International guidelines also lack satisfactory clinical direction .…”