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Philippine Clinical Practice Guidelines for Periodic Health Examination: Screening for Prenatal Disorders
Maria Julieta Corazon V Germar1, Lia M Palileo-Villanueva1, Sherri Ann L Suplido2
1College of Medicine, University of the Philippines Manila, Manila, Philippines.
Insights
This guideline offers 11 evidence-based recommendations for prenatal screening in the Philippines to reduce neonatal deaths. It supports the Universal Health Care Act by improving maternal and infant health outcomes through accessible screening services.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Evidence-Based Medicine
Background:
- Prenatal conditions are a significant cause of neonatal mortality in the Philippines, contributing to 14% of deaths in children under five.
- The Philippine Guidelines on Periodic Health Examination (PHEX) aim to enhance the quality, accessibility, and affordability of screening services, aligning with the Universal Health Care Act.
Purpose of the Study:
- To establish evidence-based recommendations for screening asymptomatic pregnant Filipino women for prenatal disorders.
- To provide healthcare professionals, patients, and policymakers with tools for informed, evidence-based decision-making in prenatal care.
Main Methods:
- The guideline development followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Evidence-to-Decision (EtD) framework.
- Systematic literature reviews of local and international guidelines were conducted, with de novo reviews performed as needed.
- A multisectoral consensus panel reviewed evidence on benefits, harms, cost-effectiveness, patient values, acceptability, feasibility, and equity.
Main Results:
- Eleven recommendations were developed for screening strategies to improve maternal and neonatal health outcomes.
- Recommendations cover screening for maternal thyroid disease, gestational diabetes mellitus, group B Streptococcus infection, fetal aneuploidy, preeclampsia risk, iron deficiency anemia, and undernutrition.
- Specific screening methods include cervical length measurements, and first and second-trimester ultrasounds.
Conclusions:
- The guideline provides 11 evidence-based recommendations tailored for the Philippine context, developed with stakeholder involvement.
- These recommendations are intended to guide prenatal screening practices until new evidence necessitates updates.
- The guideline is scheduled for review and potential update within three years.
Background:
The Philippine Guidelines on Periodic Health Examination (PHEX) support the Universal Health Care Act by providing guidance on quality, accessible, and affordable screening services for Filipinos. Conditions that develop in the prenatal period are a major cause of neonatal deaths in the Philippines and account for 14% of deaths in children under five.
Objectives:
This guideline aims to provide evidence-based recommendations for screening prenatal disorders among asymptomatic, pregnant Filipino women. It also aims to equip general practitioners, obstetricsgynecology specialists, allied health professionals, patients, policymakers, regulatory agencies, and healthcare institutions with tools and guidance that facilitate informed, evidence-based healthcare decisions for pregnant women.
Methods:
The development of this CPG followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended in the Department of Health (DOH) Manual. Recommendations were finalized using the Evidence-to-Decision (EtD) framework. Evidence Review Experts conducted a systematic literature search and critically appraised recent local and international clinical guidelines. When necessary, they conducted de novo systematic reviews. Information on the benefits and harms of screening, cost-effectiveness, patient values and preferences, acceptability, feasibility, and its impact on equity was obtained. A multisectoral consensus panel reviewed the evidence and developed recommendations. A user-friendly web application and engagement with stakeholders for promotion and implementation were among the dissemination strategies. Experts conducted an external review to provide feedback on the methodology and recommendations.
Results:
Eleven recommendations for different screening strategies to improve the health outcomes of pregnant women and neonates were developed. This CPG contains recommendations for the screening for maternal thyroid disease, gestational diabetes mellitus, group B Streptococcus infection, fetal aneuploidy, risk for preeclampsia, iron deficiency anemia, and undernutrition, and conducting cervical length measurements, first-trimester ultrasound, and second-trimester ultrasound.
Conclusion:
This CPG provides 11 evidence-based recommendations. Applicability in the local setting was carefully considered through the involvement of different stakeholders. The recommendations herein shall hold until new evidence on screening, diagnosing, or managing various risk factors and diseases emerges, or contingencies dictate updating this CPG. This guideline will be updated after three (3) years.
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