Diabetes in pregnancy: are we providing the best care ... - HQIP

More documents

Recommendations

Info

Key fi ndings of the CEMACH Diabetes Programme Two thirds of babies in the neonatal enquiry had suboptimal care on the labour ward and this frequently impacted on subsequent care. 2.9 Postnatal care Half of women in the enquiry had suboptimal postnatal diabetes care. The main underlying issues were poor management of glycaemic control after delivery, lack of contact with the diabetes team, inadequate plans of care at discharge from hospital, and no contraceptive advice given to women. Women who had a poor pregnancy outcome were more likely not to receive postnatal contraceptive advice and were more likely to have had suboptimal postnatal diabetes care. In the enquiry, women with type 2 diabetes were less likely to receive postnatal contraceptive advice. References 1. Confi dential Enquiry into Maternal and Child Health. Pregnancy in women with type 1 and type 2 diabetes in 2002-03, England, Wales and Northern Ireland. CEMACH: London; 2005. 2. The National Sentinel Caesarean Section Audit Report. Royal College of Obstetricians and Gynaecologists, Clinical Effectiveness Support Unit. RCOG Press: London; 2001. 3. Nesbitt TS, Gilbert WM, Herrhen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol; Aug 1998; 179:476-80. 4. Evans-Jones G, Kay SP, Weindling AM, Cranny G, Ward A, Bradshaw A, et al. Congenital brachial palsy: incidence, causes, and outcomes in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed; 2003; 88:F185-9. 5. Confi dential Enquiry into Maternal and Child Health. Maternity services in 2002 for women with type 1 and type 2 diabetes, England, Wales and Northern Ireland. CEMACH: London; 2004. 6. National Service Framework for Diabetes (England) Standards. Department of Health. The Stationery Offi ce: London; 2001. 6
3. Summary of recommendations This chapter includes the recommendations that have been made arising from the fi ndings of this report. Details of the process followed to derive the recommendations can be found in Chapter 5. The recommendations below apply to all women with type 1 and type 2 diabetes. Social and lifestyle issues Clinical 1. Preconception and maternity services related to pregnancy should be easily accessible and responsive to all women with diabetes, and provide appropriate care and information. 2. There should be mechanisms in place to identify vulnerable communities and individuals, so that additional services can be provided as appropriate to women of childbearing age with diabetes, thereby ensuring optimal preconception care. 3. Providers of diabetes care should develop educational strategies that will enable all women of childbearing age with diabetes to prepare adequately for pregnancy. Audit and research 4. Research should be carried out to: • identify the barriers to accessing preconception care • identify possible strategies to support self-care and pregnancy planning by women with diabetes. Clinical issues: preconception Clinical 1. Commissioners of services must ensure that all women with diabetes are provided with specialist preconception services, with access to all members of the specialist multidisciplinary team. As a minimum, these services should include: • Clear signposting to different aspects of care • Diet and lifestyle advice • Provision of appropriate contraception • Higher dose folic acid supplementation • Smoking cessation support • Assessment and management of diabetes complications • Setting of glycaemic control targets and regular discussion of results of self-monitoring, to enable the woman to achieve control that is as near to normal as possible before conception • Discussion of diabetes pregnancy risks and expected management strategies • Clear documentation of care and counselling, ideally using a standard template. 7
Page 1 and 2: Confidential Enquiry into Maternal
Page 3 and 4: Contents Acknowledgements .........
Page 5 and 6: • Members of the CEMACH Diabetes
Page 7 and 8: Erb’s palsy Injury to the nerve r
Page 9 and 10: Neonatal unit A unit which provides
Page 11 and 12: Foreword This third and fi nal repo
Page 13 and 14: 1. Introduction This is the fi nal
Page 15 and 16: 2. Key fi ndings of the CEMACH Diab
Page 17: Suboptimal fetal surveillance of ba
Page 21 and 22: 2. Patient pathways of care includi
Page 23 and 24: the pregnancies meeting this defi n
Page 25 and 26: in order to remove any identifi abl
Page 27 and 28: When deriving odds ratios for any p
Page 29 and 30: Associations are reported in Chapte
Page 31 and 32: Table 5.1 Characteristics of women
Page 33 and 34: Table 5.4 Characteristics of women
Page 35 and 36: was no information available to pan
Page 37 and 38: 6. Factors associated with poor pre
Page 39 and 40: Table 6.2 Association of clinical c
Page 41 and 42: Table 6.5 Association of specifi c
Page 43 and 44: Table 6.8 Association of postnatal
Page 45 and 46: folic acid before pregnancy (19% of
Page 47 and 48: Table 7.2 Panel comments on social
Page 49 and 50: 7.5 Conclusions One of the key fi n
Page 51 and 52: 11.Dex S, Heather J (eds). Millenni
Page 53 and 54: 8. Clinical care issues: preconcept
Page 55 and 56: chance of induction of labour was r
Page 57 and 58: 8.6.1 Enquiry fi ndings Just over h
Page 59 and 60: Some quotes from the panel discussi
Page 61 and 62: Apart from the explanation of pregn
Page 63 and 64: was associated with poor pregnancy
Page 65 and 66: of women after the fi rst trimester
Page 67 and 68: 9.5.1 Panel comments on suboptimal
Page 69 and 70:
During labour and delivery, the maj
Page 71 and 72:
Just 52% of 383 women (38% of 164 c
Page 73 and 74:
• ‘No serial growth scans perfo
Page 75 and 76:
The panel enquiries, which are in e
Page 77 and 78:
10.3.1 Enquiry fi ndings Seventy fi
Page 79 and 80:
10.6 Communication Effective commun
Page 81 and 82:
Some quotes from the panel discussi
Page 83 and 84:
working between primary and seconda
Page 85 and 86:
we therefore selected 7.2% of pregn
Page 87 and 88:
11.4 Preconception behaviour The CE
Page 89 and 90:
enquiry related to a 12 month prior
Page 91 and 92:
Table 11.10 Differences in postnata
Page 93 and 94:
Type 1 and type 2 diabetes have tra
Page 95 and 96:
Panels were chaired by the panel ch
Page 97 and 98:
In 57% (24/42) of cases, a junior d
Page 99 and 100:
Infant formula given as fi rst feed
Page 101 and 102:
2.1 hours in babies remaining with
Page 103 and 104:
12.7.1 Panel comments on suboptimal
Page 105 and 106:
The concerns described here probabl
Page 107 and 108:
External commentary Patricia Hamilt
Page 109 and 110:
informed and motivated to manage th
Page 112 and 113:
100 Appendix A: Pre-pregnancy care
Page 114 and 115:
102 Appendix B: Diabetes enquiry pr
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Appendix C Association between demo
Page 134 and 135:
Appendix C Association of preconcep
Page 136 and 137:
Appendix C Association of postnatal
Page 138 and 139:
Appendix D Association of social an
Page 140 and 141:
Appendix D Association of diabetes
Page 142 and 143:
Appendix E Association between demo
Page 144 and 145:
Appendix E Association between prec
Page 146 and 147:
Appendix E Association between post
Page 148 and 149:
Appendix F - CEMACH advisory groups
Page 150:
Appendix F - CEMACH advisory groups
show all

Diabetes in pregnancy: are we providing the best care ... - HQIP

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?