The impact of national clinical guidelines on obstetricians in Scotland

To audit reported clinical practice in relation to four national obstetric guidelines on The Preparation of the Foetus for Preterm Delivery, The Management of Mild, Non-proteinuric Hypertension in Pregnancy, The Management of Pregnancy in Women with Epilepsy and The Management of Postpartum Haemorrhage.

Questionnaire surveys before and after dissemination of the guidelines.

One hundred and sixty one consultants and senior specialist registrars in Scotland.

The response rates to the baseline and follow-up surveys were 85% and 74% respectively. Over 90% of the obstetricians kept the guidelines for reference and 85% had been prompted to change or reconsider their practice. Reported compliance improved significantly for six out of twenty nine recommendations covering: the use of tocolysis in women at risk of pre-term labour; the use of prophylactic antibiotics or entry to a clinical trial for pre-term, pre-labour rupture of the membranes; the initiation of steroid therapy in women with insulin-dependent diabetes mellitus; and the prescribing of periconceptual folic acid and vitamin K to women with epilepsy. There were no significant improvements in relation to mild, non-proteinuric hypertension or post-partum haemorrhage.

There were significant improvements in the reported management of women at risk of preterm labour and those with epilepsy. However, reported practice in relation to mild, non-proteinuric hypertension and post-partum haemorrhage has improved little. This is possibly because the guidelines for these topics were relatively complicated to understand and apply, and established patterns of practice more resistant to change.