Table 1.
Definitions of eligible antenatal contacts, screening tests, and management for the process (adherence) outcomes based on the guidelines for routine low-risk antenatal care in the West Bank, Palestine
| Screening test |
Management |
Overall outcome definition | ||
|---|---|---|---|---|
| Eligible conditions | Management algorithm | |||
| Anaemia during pregnancy | ||||
| First antenatal contact | Haemoglobin test | Mild anaemia (haemoglobin 10·0–10·9 g/dL) | Repeat haemoglobin test within 4 weeks* | Screening with haemoglobin test and screening normal; and appropriate management if anaemia is detected |
| Antenatal contact at 24–28 weeks | Haemoglobin test | Moderate anaemia (haemoglobin 7·0–9·9 g/dL) | Repeat haemoglobin test within 4 weeks* | Screening with haemoglobin test and screening normal; and appropriate management if anaemia is detected |
| Antenatal contact at 36 weeks | Haemoglobin test | Severe anaemia (haemoglobin <7·0 g/dL) | Referral to hospital | Screening with haemoglobin test and screening normal; and appropriate management if anaemia is detected |
| Hypertension during pregnancy | ||||
| First antenatal contact | Blood pressure measurement | Mild gestational hypertension (systolic blood pressure 140–149 mm Hg or diastolic blood pressure 90–99 mm Hg) | Repeat blood pressure measurement within 4 days of the first measurement | Screening with blood pressure measurement and blood pressure within the normal range; and appropriate management if gestational or chronic hypertension is detected |
| Antenatal contact at 16 weeks | Blood pressure measurement | Moderate gestational hypertension (systolic blood pressure 150–159 mm Hg or diastolic blood pressure 100–109 mm Hg) | Referral to high-risk clinic or hospital | Screening with blood pressure measurement and blood pressure within the normal range; and appropriate management if gestational or chronic hypertension is detected |
| Antenatal contact at 18–22 weeks | Blood pressure measurement | Severe gestational hypertension (systolic blood pressure >160 mm Hg or diastolic blood pressure >110 mm Hg) | Referral to high-risk clinic or hospital | Screening with blood pressure measurement and blood pressure within the normal range; and appropriate management if gestational or chronic hypertension is detected |
| Antenatal contact at 24–28 weeks | Blood pressure measurement | Chronic hypertension | Referral to high-risk clinic or hospital | Screening with blood pressure measurement and blood pressure within the normal range; and appropriate management if gestational or chronic hypertension is detected |
| Antenatal contact at 32 weeks | Blood pressure measurement | Chronic hypertension | Referral to high-risk clinic or hospital | Screening with blood pressure measurement and blood pressure within the normal range; and appropriate management if gestational or chronic hypertension is detected |
| Antenatal contact at 36 weeks | Blood pressure measurement | Chronic hypertension | Referral to high-risk clinic or hospital | Screening with blood pressure measurement and blood pressure within the normal range; and appropriate management if gestational or chronic hypertension is detected |
| Diabetes during pregnancy | ||||
| First antenatal contact before 24 weeks | Urine sugar test or blood sugar test | Positive random blood sugar test (≥140 mg/dL) | Referral to high-risk clinic or hospital | Screening with urine or blood sugar test and screening normal; and appropriate management if a high blood sugar is detected |
| First antenatal contact after 28 weeks | Blood sugar test | Positive random blood sugar test (≥140 mg/dL) | Referral to high-risk clinic or hospital | Screening with urine or blood sugar test and screening normal; and appropriate management if a high blood sugar is detected |
| Antenatal contact at 24–28 weeks | Blood sugar test | Positive random blood sugar test (≥140 mg/dL) | Referral to high-risk clinic or hospital | Screening with urine or blood sugar test and screening normal; and appropriate management if a high blood sugar is detected |
| Abnormal foetal growth | ||||
| First antenatal contact after 20 weeks | Symphysis fundal height or ultrasound examination | Discrepancy between fundal height and gestational age of greater than 2 or lesser than −2; ultrasound suspected foetal growth abnormalities | Ultrasound examination within 1 week; referral to high-risk clinic or hospital | Screening with antenatal ultrasound or symphysis fundus height measurement and screening normal; and appropriate management if a discrepancy between the symphysis fundus height and gestational age or foetal growth abnormalities are detected in ultrasound |
| Malpresentation during pregnancy† | ||||
| Antenatal contact at 36 weeks | Presentation checked by abdominal palpation or antenatal ultrasound | Non-cephalic presentation | Referral to hospital | Screening with abdominal palpation, or antenatal ultrasound for foetal presentation and presentation cephalic; and appropriate management if non-cephalic presentation |
*
Haemoglobin is measured after 4 weeks of treatment with oral iron and folic acid supplementation for mild and moderate anaemia. Treatment with oral iron and folic acid supplements was not measured as part of the management due to unreliable documentation in the clinical records.
†
Secondary outcome.