title: Evaluation of the quality of guidelines for the management of reduced fetal movements in UK maternity units.
abstract: BACKGROUND
  The development of evidence-based guidelines is a key step in ensuring that maternity care is of a universally high standard. To influence patient care national and international guidelines need to be interpreted and implemented locally. In 2011, the Royal College of Obstetricians and Gynaecologists published guidelines for the management of reduced fetal movements (RFM), which can be an important symptom of fetal compromise. Following dissemination it was anticipated that this guidance would be implemented in UK maternity units. This study aimed to assess the quality of local guidelines for the management of RFM in comparison to published national standards.
  
  
  METHODS
  Cross-sectional survey of maternity unit guidelines for RFM. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool and scored by two independent investigators. Two national guidelines were used as standards to evaluate unit guidelines.
  
  
  RESULTS
  Responses were received from 98 units (42%); 12 units had no guideline. National guidelines scored highly using the AGREE II tool but there was wide variation in the quality of individual maternity unit guidelines, which were frequently of low quality. No guidelines incorporated all the recommendations from the national guideline. Maternity unit guidelines performed well for clarity and presentation but had low scores for stakeholder involvement, rigour of development and applicability.
  
  
  CONCLUSIONS
  In contrast to national evidence based guidance the quality of maternity unit guidelines for RFM is variable and frequently of low quality. To increase quality, guidelines need to include up to date evidence and audit standards which could be taken directly from national evidence-based guidance. Barriers to local implementation and resource implications need to be taken into consideration. Training may also improve the implementation of the guideline. Research is needed to inform strategies to realize the benefits of clinical guidance in practice.
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Oxford Road, Manchester, UK. stephanie.jokhan@student.manchester.ac.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. stephanie.jokhan@student.manchester.ac.uk.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Jokhan
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Oxford Road, Manchester, UK. melissa.whitworth@cmft.nhs.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. melissa.whitworth@cmft.nhs.uk.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Whitworth
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Oxford Road, Manchester, UK. felicity.jones22@doctors.org.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. felicity.jones22@doctors.org.uk.
authors.forename: Felicity
authors.initials: F
authors.lastname: Jones
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Oxford Road, Manchester, UK. ashleigh.saunders@doctors.org.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. ashleigh.saunders@doctors.org.uk.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Saunders
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, Oxford Road, Manchester, UK. alexander.heazell@manchester.ac.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK. alexander.heazell@manchester.ac.uk.
authors.forename: Alexander E P
authors.initials: AE
authors.lastname: Heazell
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005324:Fetal Movement; D005328:Fetal Viability; D019538:Health Care Surveys; D006801:Humans; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011314:Preventive Health Services / Q000379:methods / Q000592:standards; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D050497:Stillbirth; D006113:United Kingdom / Q000453:epidemiology