MATERNAL AND EARLY CHILD HEALTH

Health Evidence Bulletins - Wales

Original Protocol Statements

(Original Welsh protocol intervention in brackets)

The original Protocols for Investment in Health Gain were written in the early 1990s to suggest areas where the introduction, or more widespread use, of certain practices could lead to worthwhile improvements in health for the people of Wales. The documents also highlighted current practices which were of questionable value. This Bulletin has been prepared by reviewing the earlier Protocol for Investment in Health Gain: Maternal and Early Child Health(1) to provide some clear, updated statements with a precise indication of the strength of the evidence and its sources for each statement; and to introduce new statements covering subjects of important current interest.

In certain areas, elements of the original statements have not been included into the revised statements.  Where this occurs, reasons for omission are given.  The original Welsh Protocol intervention is given in brackets after each statement, these refer to the following;

Original Welsh Protocol intervention

  1. Interventions that increase health gain
  2. Interventions that appear promising but require further evaluation
  3. Interventions with uncertain effects which require further evaluation
  4. Interventions that should be abandoned in light of available evidence

Top

1- Miscarriage and ectopic pregnancy (early haemorrhage)

2 - Hypertensive disorders of pregnancy

Top

3 - Medical disorders of pregnancy

4 - Infections in pregnancy

Top

5 - Support in pregnancy

8 - Thromboembolism in pregnancy

Top

Record of elements of original statements not incorporated into the revised statements

Subject Reasons for omission
Minimise surgical interventions (1) Covered in Chapter 12 ‘Interventions
Stop smoking Covered in Chapter 14 ‘Suspected fetal compromise
General advice on diet etc (1) accepted good practice
Reduce obesity, prevent anaemia (1) accepted good practice

9 - Haemorrhage in late pregnancy (and labour)

Top

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Minimise obstetric interventions (1) Covered in Chapter 12 ‘Interventions
Prophylactic oxyotocic drugs in management of 3rd stage of labour (1) Covered in Chapter 16 ‘Postpartum haemorrhage

10 - Where to be born

Top

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Minimise obstetric intervention (1) Covered in Chapter 12 ‘Interventions
Continuity of care (1) Covered in Chapter 5 ‘Support in pregnancy

11 - Control of pain in labour

13 - Premature labour

Top

15 - Maternal support in labour

16 - Postpartum haemorrhage

Top

Record of elements of the original statements not incorporated into the revised statements

Subject

Minimise obstetric interventions (1)

Reasons for omission

covered in Chapter 12 ‘Interventions

18 - Maternal support during the puerperium and bereavement

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Avoid separation of mother and child(1)

Continuity of care (1)

Both covered in Chapter 15 ‘Maternal support in labour
Edinburgh perinatal depression scales (1) Other scales could be equally valid

Top

19 - Care of the low birth weight baby

Top

Record of elements of the original statements not incorporated into the revised statements

Subject Reasons for omission
Avoid teenage pregnancy This statement is relevant to the Healthy Living Bulletin (due for publication late 1997)
Prevent multi pregnancies in assisted conception (limit eggs/ova to maximum of 3) (1) Accepted good practice in a specialised area

20 - Neonatal respiratory support

22 - Congenital anomalies

Top

23 - Sudden infant death syndrome

Three practices to avoid:

Records of elements of the original statements not incorporated into the revised statements

Subject

Bereavement counselling (1)

Reasons for omission

Covered in Chapter 18 ‘Support in the puerperium and bereavement

Top

Contents Home

Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk