Haran C, van Driel M, Mitchell BL, Brodribb
WE(1).
BACKGROUND: While 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.
METHODS: PubMed, 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.
RESULTS: Six 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.
CONCLUSIONS: Only 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.
