Philippine Clinical Practice Guidelines for Periodic Health Examination: Screening for Prenatal Disorders
Germar, MD, DHPEd MJCV., De Castro, MD LRO., Sucaldito, MD MSFC., Yoshida, MD ASR., Geroy, MD, MPH, MSc LSA., Udaundo Estrada, RM, BSN, BSM, MPH E., Garcia, MD DEC., Sta. Ana, Jr., MD, MPH FB., Elises-Molon, MD KTR., Silverio-Fernando, MD KK., Velayo, MD, PhD CL., David–Bustamante, MD LM., Diosana J-AL., Silvestre, MD MAA., Cruz MD MGD., Cerrado, MD, MSc JPB., Villafuerte, MD ARC., Palileo-Villanueva, MD, MSc LM., Suplido, MD SAL., Villaluz, MD MSB., Gianan, MD, MPH MJA., Sy, MD EH., Betha Fe M. Castillo, MD BFMCMD., Boransing, MD PMP., De Peralta-Yambao, MD HB., Cacas, MD MTG., Besa, MD, MPH JJV., Masamayor, RN, MD EMI., Malijan, MD, MSc GMB., Villanueva, MD, MPH CAG., Infantado-Alejandro, PTRP MAJ.
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 evidencebased 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.