This is not the most recent version of the article. View current version (6 OCT 2010)
Intervention Review
Patterns of routine antenatal care for low-risk pregnancy
Editorial Group: Cochrane Pregnancy and Childbirth Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 17 AUG 2001
DOI: 10.1002/14651858.CD000934
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Villar J, Carroli G, Khan-Neelofur D, Piaggio GGP, Gülmezoglu AM. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000934. DOI: 10.1002/14651858.CD000934.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
This is not the most recent version of the article.View current version (06 Oct 2010)
Abstract
Background
It has been suggested that reduced antenatal care packages or prenatal care managed by providers other than obstetricians for low risk women can be as effective as standard models of antenatal care.
Objectives
The objective of this review was to assess the effects of antenatal care programmes for low-risk women.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group trials register, reference lists of articles and we also contacted researchers in the field. Date of last search: May 2001
Selection criteria
Randomised trials comparing programmes of antenatal care with varied frequency and timing of the visits and different types of care providers.
Data collection and analysis
Trial quality was assessed and data were extracted by two reviewers independently. Study authors were contacted for additional information and they were provided with the final version of the review.
Main results
Ten trials involving over 60,000 women were included. Seven trials evaluated the number of antenatal clinic visits, and three trials evaluated the type of care provider. Most trials were of acceptable quality. A reduction in the number of antenatal visits was not associated with an increase in any of the negative maternal and perinatal outcomes reviewed. However, trials from developed countries suggest that women can be less satisfied with the reduced number of visits and feel that their expectations with care are not fulfilled. Antenatal care provided by a midwife/general practitioner was associated with improved perception of care by women. Clinical effectiveness of midwife/general practitioner managed care was similar to that of obstetrician/gynaecologist led shared care.
Authors' conclusions
A reduction in the number of antenatal care visits with or without an increased emphasis on the content of the visits could be implemented without any increase in adverse biological maternal and perinatal outcomes. Women can be less satisfied with reduced visits. Lower costs for the mothers and providers could be achieved. While clinical effectiveness seemed similar, women appeared to be slightly more satisfied with midwife/general practitioner managed care compared with obstetrician/gynaecologist led shared care.
Plain language summary
Patterns of routine antenatal care for low-risk pregnancy
Lowering the number of routine prenatal visits does not jeopardise health outcomes for pregnancy women or their babies, but may reduce women's satisfaction with care.
A routine number of pregnancy visits (antenatal or prenatal care) has developed, without evidence of how much care is necessary or helpful. These visits can include tests, education and other health checks. They are provided by midwives, general practitioners (family doctors) or specialist doctors (obstetricians or gynaecologists). The review of trials found that each of these professional groups provide equally effective antenatal care to healthy low-risk pregnant women. Women are slightly more likely to be happy with midwifery or general practitioner care. Good health outcomes can still be achieved with fewer visits, but this might reduce women's satisfaction with their care.