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Antenatal day care units versus hospital admission for women with complicated pregnancy

  • Review
  • Intervention

Authors

  • Christel C Kröner,

    1. The University of Liverpool, C/o Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, LIverpool, UK
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  • Deborah A Turnbull,

    Corresponding author
    1. University of Adelaide, Departments of General Practice and Psychology, Adelaide, SA, Australia
    • Deborah A Turnbull, Departments of General Practice and Psychology, University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia. deborah.turnbull@adelaide.edu.au.

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  • Christopher S Wilkinson

    1. Women's and Children's Hospital, Department of Perinatal Medicine, Adelaide, South Australia, Australia
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Abstract

Background

The use of antenatal day care units is widely recognized as an alternative for inpatient care for women with complicated pregnancy.

Objectives

The objective of this review was to assess the clinical safety, plus maternal, perinatal and psychosocial consequences for the women and cost effectiveness of this type of care.

Search strategy

The Group's Specialised Register of Controlled Trials was searched in May 2001 as well as the Cochrane Controlled Trials Register (CENTRAL/CCTR), CINAHL (1982-04 to 1998-10) and Current Contents (Life Sciences/Clinical Medicine 1995-05 to 1999). Conference proceedings of PSANZ (Perinatal Society of Australia and New Zealand) and FIGO (Fédération Internationale de Gynécologie et d'Obstétrie) (1997) were searched.

Selection criteria

Randomized trial comparing day care with inpatient care for women with complicated pregnancy.

Data collection and analysis

Trial quality was assessed by two reviewers independently. The author of the study was contacted for additional information. Data were extracted by the same two reviewers independently.

Main results

One trial involving 54 women was included. This trial was of average quality. It was found that day care assessment for non-proteinuric hypertension can reduce inpatient stay (difference in mean stay: 4.0 days; 95% confidence interval (CI): 2.1 to 5.9 days). Also a significant increase in the rate of induction of labour in the control group was found (4.9 times more likely: 95% CI: 1.6 to 13.8). The other clinical outcomes did not show a statistically significant difference between the control and intervention group. No other significant differences were observed.

Authors' conclusions

Admission to day care for non-proteinuric hypertension reduces the amount of time spent in the hospital and proportion of women induced for labour. However, one trial of 54 women is not sufficient to draw sound conclusions. Additional studies are needed to give more solid evidence to confirm the advantages of antenatal day care units.

Plain language summary

Antenatal day care units versus hospital admission for women with complicated pregnancy

Some evidence exists that admission to antenatal day care units may help reduce the length of time spent in hospital for women with a complicated pregnancy.

Complications during pregnancy can include high blood pressure, excessive vomiting, threatened early labour or abnormal and heavy bleeding (haemorrhage). Admission to hospital is necessary but disruptive to the mother and her family. Sometimes this care can be given without the need for an overnight stay in hospital. Day care units can provide a more relaxed atmosphere and better access for families, while still providing high quality medical and midwifery care. The review of trials found some evidence that inpatient stay and the rate of induced labour was reduced by admission to day care units but more research is needed.