Document Detail

Alternative versus standard packages of antenatal care for low-risk pregnancy.
MedLine Citation:
PMID:  20927721     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation.
OBJECTIVES: To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010), reference lists of articles and contacted researchers in the field.
SELECTION CRITERIA: Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care.
DATA COLLECTION AND ANALYSIS: Two authors assessed trial quality and extracted data independently.
MAIN RESULTS: We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more 'goal oriented'.Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1.32). Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02). There were no clear differences between the groups for the other reported clinical outcomes.Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs.
AUTHORS' CONCLUSIONS: In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.
Therese Dowswell; Guillermo Carroli; Lelia Duley; Simon Gates; A Metin Gülmezoglu; Dina Khan-Neelofur; Gilda Gp Piaggio
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2010-10-06
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2010  
Date Detail:
Created Date:  2010-10-07     Completed Date:  2010-11-30     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD000934     Citation Subset:  IM    
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MeSH Terms
Developed Countries
Developing Countries
Family Practice
Office Visits* / utilization
Patient Satisfaction
Perinatal Mortality
Pregnancy Outcome
Prenatal Care / standards*,  utilization
Program Evaluation
Randomized Controlled Trials as Topic
Grant Support
CPGS02//Department of Health
Comment In:
Evid Based Nurs. 2011 Apr;14(2):55-6   [PMID:  21421980 ]
Update Of:
Cochrane Database Syst Rev. 2001;(4):CD000934   [PMID:  11687086 ]

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