Clinical Practice Guidelines Antenatal care - Module I


Page last updated: 02 April 2013

Aboriginal and Torres Strait Islander peoples — It is recognised that there is no single Aboriginal or Torres Strait Islander culture or group, but numerous groupings, languages, kinships, and tribes, as well as ways of living. Furthermore, Aboriginal and Torres Strait Islander peoples may currently live in urban, rural or remote settings, in urbanised, traditional or other lifestyles, and frequently move between these ways of living.

Acupressure — Acupressure is a noninvasive variation of acupuncture that involves application of constant pressure to specific points or areas.

Acustimulation — Mild electrical stimulation to specific points or areas.

Amniocentesis — A diagnostic test for chromosomal abnormalities, such as trisomy 21 (Down syndrome), where an ultrasound guided needle is used to extract a sample of the amniotic fluid.

Antiretroviral treatment — the use of medicines to reduce growth of retroviruses, primarily HIV.

Chorionic villus sampling (CVS) — diagnostic test for chromosomal abnormalities such as trisomy 21 (Down syndrome) where an ultrasound guided needle is used to extract a sample of the placenta.

Citation bias — The citation or non-citation of research. Citing of trials in publications is not objective so retrieving studies using this method alone may result in biased results. Unsupported studies tend to be cited often which may also bias results.

Cleft lip and/or palate — variations of a congenital abnormality caused by non-fusion of embryonic facial lobes.

Cognitive-behavioural therapy — Psychological therapy based on the assumption that faulty thinking patterns, maladaptive behaviours and “negative” emotions are all inter-related. Treatment focuses on changing an individual’s thoughts (cognitive patterns) or maladaptive behaviours in order to change emotional states. Cognitive-behavioural therapy integrates the cognitive restructuring approach of cognitive therapy with the behavioural modification techniques of behavioural therapy.

Culturally and linguistically diverse background — Applies to women whose first language is one other than English, or whose family background involves migration from a non-English speaking country. It can refer to new arrivals to Australia as immigrants or refugees from non-English speaking countries as well as the children of migrant parents.

Ectopic pregnancy — a pregnancy in which implantation of the fertilised egg takes place outside the uterus, usually in a fallopian tube. Ectopic pregnancies usually result in miscarriage but can cause rupture of the fallopian tube and severe internal bleeding.

Edinburgh Postnatal Depression Scale (EPDS) — The EPDS was developed and validated as a screening tool for depression in the postnatal period. It has subsequently been validated for use in pregnant women and is therefore appropriate for use throughout the perinatal period.

Educational and motivational interviewing strategies — Education strategies given to all members of the intervention group. Counselling delivered by a number of means: through primary carer, medical professional, professional counsellor, targeted printed material etc.

First antenatal visit – The first visit specifically for antenatal care following confirmation of the pregnancy.
Top of page
First contact — The visit in which a woman attends to confirm pregnancy, seek antenatal care or make arrangements for the birth.

Herbal medicines — Preparations such as tablets, tinctures and infusions that are made from plant parts. These preparations are usually formulated based on traditional uses of Western or Chinese herbs.

Induction of labour — A procedure to artificially start the process of labour by way of medical, surgical or medical and surgical means.

Interventions based on stages of change (smoking cessation) — Similar to cognitive behavioural and education strategies, except that these interventions were grouped separately as they involve assessment of “readiness” to change and exposure to the intervention may be more selective.

Low birth weight — Birth weight of less than 2500g.

Maternal serum screening — A blood test performed during pregnancy to detect markers of chromosomal abnormality, such as trisomy 21 (Down syndrome).

Miscarriage — the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans as before 20 weeks.

Nuchal translucency thickness assessment — An ultrasound scan performed between 11 and 13 weeks of pregnancy that measures the thickness of the nuchal fold behind the fetus’ neck – a marker of chromosomal abnormality, such as trisomy 21 (Down syndrome).

P6 (or Neiguan) point — an acupuncture point located on the anterior aspect of the forearm near the wrist.

Passive smoking — The inhalation of smoke, called second-hand smoke or environmental tobacco smoke, from tobacco products used by others.

Perinatal period — For the purposes of these guidelines, ‘perinatal’ is defined as the period covering pregnancy and the first year following pregnancy or birth. It is acknowledged that other definitions of this term are used for data collection and analysis. The definition used here broadens the scope of the term perinatal in line with understanding of mental health in pregnancy and following birth.

Pharmacotherapies (smoking cessation) — Studies cited in Lumley et al 2009 used nicotine replacement therapy, as patches, gum or lozenge. Other studies considered bupropion or other pharmacological agents.

Placenta praevia — An obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix.

Placental abruption — A potentially life-threatening obstetric complication in which the placental lining separates from the uterus of the mother.

Preterm birth — Birth at less that 37 weeks’ gestation.

Psychosocial support (smoking cessation) — Includes discussion groups, provision of support materials (unless CBT-based), provision of telephone support etc.

Pyelonephritis — an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney.

Rewards and incentives (smoking cessation) — Intervention group provided rewards or incentives (payment; one study provided a lottery for participants), usually based on smoking status evaluated by biochemical markers.

Stillbirth — The birth of a baby that has died in the uterus after 20 weeks of pregnancy or reaching a weight of more than 400g if gestational age is unknown.

Sudden infant death syndrome — a syndrome marked by the sudden death of an infant that is unexpected by history and remains unexplained after a thorough forensic autopsy and a detailed death scene investigation.

Trisomy 13 — A genetic disorder in which a person has three copies of genetic material from chromosome 13, instead of the usual two copies. Also referred to as Patau syndrome or trisomy D.

Trisomy 18 — A genetic disorder caused by the presence of all or part of an extra 18th chromosome. Also referred to as Edwards syndrome or trisomy E.
Top of page
Trisomy 21 — Chromosomal abnormality due to an additional chromosome 21. Also referred to as Down syndrome.

Woman-focused communication skills — These involve techniques and attitudes that indicate respect for the woman, a willingness to listen to her perspectives, values and current life circumstances around antenatal concerns, and not direct the woman into any particular course of action. Woman-centred communication skills can include giving appropriate information, but always includes communication that views the woman as a capable and responsible person, and creates a respectful, supportive and effective alliance between the woman and the health professional.

Methodological terms

ADAPTE framework — A systematic approach to aid in the adaptation of guidelines produced in one setting to be used in a different cultural and/or organisational context.

AGREE — A framework for assessing the quality of clinical practice guidelines, including that the potential biases of guideline development have been addressed adequately and that the recommendations are both internally and externally valid, and are feasible for practice. This process involves taking into account the benefits, harms and costs of the recommendations, as well as the practical issues attached to them. Therefore, the assessment includes judgements about the methods used for developing the guidelines,
the content of the final recommendations, and the factors linked to their uptake.

Citation bias — The citation or non-citation of research. Citing of trials in publications is not objective so retrieving studies using this method alone may result in biased results. Unsupported studies tend to be cited often which may also bias results.

Consensus-based recommendation — Recommendations based on systematic review of the literature where evidence is found to be limited or lacking.

Language bias — The publication of research findings in a particular language. Significant results are more likely to be published in English so a search limited to English-language journals may result in an overestimation of effect.

Multiple publication bias — The multiple or singular publication of research findings. Studies with significant results tend to be published multiple times which increases the chance of duplication of the same data and may bias the results of a review.

Odds ratio — the ratio of the likelihood of an event occurring in one group to that of it occurring in another group. An odds ratio of 1 indicates that the condition or event under study is equally likely to occur in both groups. An odds ratio greater than 1 indicates that the condition or event is more likely to occur in the first group and an odds ratio less than 1 indicates that the condition or event is less likely to occur in the first group.

Outcome reporting bias — The selective reporting of some outcomes but not others. Outcomes with favourable findings may be reported more. For example, adverse events have been found to be reported more often in unpublished studies. This may result in more favourable results for published studies.

Practice point — For the purposes of these Guidelines, these cover areas of antenatal care that were beyond the scope of the literature reviews but where the EAC or Working Group for Aboriginal and Torres Strait Islander Women’s Antenatal Care determined there was a need for advice. These points are based on best practice clinical judgement.

Publication bias — The publication or non-publication of research findings. Small, negative trials tend not to be published and this may lead to an overestimate of results of a review if only published studies are included.

Randomised controlled trial — A study in which participants are allocated at random to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo or no intervention at all.

Recommendation — Evidence-based action statement developed through systematic review of the literature and graded based on consideration of the evidence base, consistency of the evidence, clinical impact of the proposed recommendation and generalisability and applicability of the evidence.

Relative risk — The ratio of the risk (rate) of an outcome in an exposed group (eg to a specific medicine) to the risk (rate) of the outcome in an unexposed group in a specified time period.

Sensitivity — The proportion of people with the condition who have a positive test result.

Specificity — The proportion of people without the condition who have a negative test result.

Systematic literature review — A systematic review of evidence focused on a research question(s) that aims to identify, appraise, select and synthesise all high quality research evidence relevant to that question.

Time-lag bias — The rapid or delayed publication of research findings. Studies with positive results tend to be published sooner than studies with negative findings and hence results may be overestimated until the negative studies ‘catch up’.

Department of Health and Ageing website

All information in this publication is correct as of November 2012

D0791 November 2012

Top of page