Document Detail


Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes.
MedLine Citation:
PMID:  9033238     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Scope and content of antenatal care programs are ritualistic rather than evidence-based. We wanted to identify elements of antenatal care which are of proven benefit in preventing or ameliorating specific adverse outcomes in the mother: bleeding, anemia, preeclampsia, sepsis and genito-urinary infection and obstructed labor. METHODS: Review of recent literature, especially randomized controlled trials. RESULTS AND CONCLUSIONS: Recent trials indicate that fewer routine visits for low-risk women do not put pregnancies at increased risk but may lessen patient satisfaction. Bleeding in pregnancy has many causes, none of which can be eliminated through antenatal care. Risk factors can be identified by history-taking. Counselling and advice on what to do is the best option. Anemia in pregnancy is common, especially in developing countries. Routine iron supplementation is not necessary in well-nourished populations, but iron and folate should be provided for every pregnant woman in areas of high anemia prevalence; based on circumstantial evidence. Hemoglobin (Hb) determination as a routine test is more important late (around week 30) than early in pregnancy: high Hb is a danger signal. It is uncertain whether early detection of pre-eclampsia will reduce the incidence of eclampsia. Recent trials do not support routine aspirin to prevent pre-eclampsia among low risk women, nor is there evidence that anti-hypertensive treatment of mild pre-eclampsia will prevent more severe disease, but improved detection and care may still lead to better outcome. As to infections, urine culture and dipstick for leucocyte esterase and nitrite with subsequent treatment of positive cases will reduce the risk of pyelonephritis and appears to be cost-effective. Serological screening and treatment of syphilis is inexpensive and cost-effective. Obstructed labor can be anticipated in multiparas based on obstetrical history. Hospital delivery should be secured. Height of nulliparas should be recorded where hospital birth is not routine and a discriminatory level for hospital delivery decided locally. External version of breech lie does reduce the incidence of breech births and cesarean delivery.
Recent literature was reviewed to identify elements of antenatal care which are of proven benefit in preventing or ameliorating adverse outcomes in the mother such as bleeding, anemia, pre-eclampsia, sepsis and genitourinary infection, and obstructed labor. Recent trials indicate that while fewer routine visits for low-risk women do not jeopardize a positive pregnancy outcome, patients may be less satisfied. None of the many factors which can cause bleeding during pregnancy can be eliminated through antenatal care, although risk factors can be identified through history-taking. Counseling on what to do is the best option. Routine iron supplementation against anemia is not necessary in well-nourished populations, but circumstantial evidence suggests that iron and folate should be provided for every pregnant woman in areas of high anemia prevalence. Hemoglobin determination as a routine test is more important near week 30 of term rather than early in pregnancy. Recent trials do not support routine aspirin to prevent pre-eclampsia among low-risk women, nor is there evidence that anti-hypertensive treatment of mild pre-eclampsia will prevent more serious disease. Improved detection and care may, however, lead to better outcomes. Urine culture and dipstick for leucocyte esterase and nitrite with subsequent treatment of positive cases will reduce the risk of pyelonephritis and appear to be cost-effective. Serological screening and treatment of syphilis is inexpensive and cost-effective, while obstructed labor can be anticipated in multiparas based upon obstetrical history; hospital delivery should be secured.
Authors:
J Villar; P Bergsjø
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  76     ISSN:  0001-6349     ISO Abbreviation:  Acta Obstet Gynecol Scand     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-03-11     Completed Date:  1997-03-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  1-14     Citation Subset:  IM; J    
Affiliation:
Special Programme of Research, Development & Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Developed Countries
Developing Countries
Evidence-Based Medicine
Female
Humans
Mothers*
Pregnancy
Pregnancy Complications / prevention & control*
Prenatal Care*
Randomized Controlled Trials as Topic

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