Table 1 List of quality of care indicators

Part A. accepted indicators

Initiation and number of antenatal visits

1

Percentage of pregnant women who began ANC during the first trimester of gestation

2

Percentage of women with low risk pregnancy^† who at the end of the pregnancy had at least four ANC visits

Health education

3

Percentage of pregnant women who had documented educational activities provided by the maternity nurse or social worker

4

Percentage of overweight/obese (pre-pregnancy BMI ≥ 25 kg/m2) pregnant women who had documented nutritional counselling provided by the nutrition service

Screening

5

Percentage of pregnant women who were referred to or had documented Rh and blood group test

6

Percentage of pregnant women who were referred to haemoglobin test during the first two ANC visits

7

Percentage of pregnant women who were referred to fasting plasma glucose test during the first two ANC visits and between weeks 24 and 28 of gestation

8

Percentage of pregnant women who were referred to obstetric ultrasound between weeks 18 and 22 of gestation

9

Percentage of pregnant women who were referred to VDRL test (syphilis screening) during the first two ANC visits

Nutritional supplementation

10

Percentage of pregnant women who had prescription of folic acid during the first trimester of gestation

Treatment and referrals to the obstetrician-gynecologist

11

Percentage of pregnant women diagnosed with bacterial vaginosis or trichomoniasis, who had vaginal metronidazol prescription in adequate doses and duration

12

Percentage of pregnant women with systolic blood pressure ≥ 140 mmHg, or diastolic blood pressure ≥ 90 mmHg who was referred to the second or third level of care

13

Percentage of pregnant women with pre-existing degenerative chronic disease (diabetes, hypertension, lupus, heart disease) who were referred to the second or third level of care

14

Percentage of pregnant women between 20–32 weeks with symphysis-fundal height 4 cm less than indicated by their gestational age, who were referred to ultrasound or another level of care

Part B. Discarded indicators

Reasons of elimination

1. Percentage of pregnant women who had documented risk assessment at the first ANC visit.

These processes of care correspond to the mandatory fields in the EHR, so the family doctor and other health care professional cannot move along EHR without fill out these fields.

2. Percentage of pregnant women who had their blood pressure measured at each ANC visit.

3. Percentage of pregnant women who had their weight measured at each ANC visit.

4. Percentage of pregnant women who had their symphysis-fundal height measured at each ANC visit from 24 weeks of gestation.

5. Percentage of pregnant women who underwent a urine protein test at each visit from 20 weeks of gestation.

The urine protein test is not routinely performed in most IMSS family medicine clinics.

6. Percentage of pregnant women who underwent screening for HIV.

Such tests are not available at IMSS FMCs. To mitigate this limitation, the IMSS clinical guideline recommends identifying those patients at risk for these diseases in primary care and referring them to the second or third level of care.

7. Percentage of pregnant women who underwent screening for hepatitis B.

8. Percentage of pregnant women who underwent screening for measles.

9. Percentage of smoking pregnant women who underwent smoking cessation counselling.

The information is not routinely registered at the EHR.

10. Percentage of pregnant without previous tetanus toxoid immunization women who had documented indication for this immunization during the first trimester of gestation.

11. Percentage of multigravid Rh negative pregnant women with

Rh-positive partner who was referred to the second or third level of care before week 28 of gestation.

12. Percentage of pregnant women who had premature birth (≤37 weeks) newborn.

13. Percentage of pregnant women who had low birth weight (<2500 g) newborn.