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

Clinical governance
10.5 Maternity unit guidelines
CNST emphasises the importance of evidence-based, referenced, multidisciplinary guidelines which are
easily accessible to the health professionals providing care. 4 For each woman in the enquiry, panels were
asked to review the local maternity unit’s diabetes guideline (contemporaneous for 2002-2003) when these
had been provided by the unit. An individual unit’s guideline may have been reviewed more than once by
panels, and the results are therefore presented as the proportion of women to whom any concerns related.
Enquiry panels had concerns about local maternity units’ diabetes guidelines for nearly three quarters
(72%) of 386 women where unit guidelines were available.
10.5.1 Panel comments on maternity unit diabetes guidelines
Panels made 386 comments about the local diabetes guidelines for 278 women. The two most frequent
issues cited were no antenatal guidelines and lack of clarity or insuffi cient detail (table 10.2). For nearly a
quarter of the women, the panels’ view was that intravenous insulin regimes for labour were inadequate,
and for approximately a fi fth of the women the guideline did not include blood glucose targets. There was
considered to be wrong or inappropriate advice in the guidelines for more than a tenth of women assessed
to have suboptimal local guidelines.
Table 10.2
Panel comments on suboptimal maternity unit diabetes guidelines (table contains information following
categorisation of free text)
Number of women with suboptimal local
guidelines
(N=278)
No. of comments
% of women
Total comments* 386 -
No antenatal guideline 80 29
Not enough detail/not clear 70 25
Inadequate intravenous insulin regime for labour 64 23
Blood glucose issues (mainly no targets set) 57 21
Wrong/inappropriate advice in guideline 35 13
No postnatal guideline 24 9
Out of date 19 7
No guidance on management during antenatal
steroid administration 16 6
No advice on screening or management
of diabetes complications 9 3
Not referenced 6 2
Recommends routine admission of baby to neonatal unit 6 2
* hospital protocols not available or data missing for 56 women.
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