WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care.
Background: We undertook a multicentre randomised controlled trial that compared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits.Methods: Clinics in Argentina, Cuba, Saudi Arabi...
| Publicado en: | Lancet Vol. 357; no. 9268; pp. 1551 - 1565 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | clinical trial research tables/charts Journal Article |
| Publicado: |
Lancet
5/19/2001
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107076616&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107076616 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 5/19/2001 vid: 357 iid: 9268 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 107076616 107076616 NLM11377642 2001113923 10.1016/s0140-6736(00)04722-x NLM11377642 107076616 ppf: 1551 ppct: 14 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. aug: au: Villar J Ba'aqeel H Piaggio G Lumbiganon P Belizán JM Farnot U Al-Mazrou Y Carroli G Pinol A Donner A Langer A Nigenda G Mugford M Fox-Rushby J Hutton G Bergsjø P Bakketeig L Berendes H Villar, J Ba'aqeel, H affil: UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland sug: subj: Prenatal Care World Health Organization Pregnancy Complications Prevention and Control Prenatal Care Methods Prenatal Care Utilization Checklists Maternal Welfare Argentina Cuba Saudi Arabia Thailand Risk Factors Pregnancy Patient Compliance Patient Satisfaction Clinical Trials Confidence Intervals Female Funding Source Human Female ab: Background: We undertook a multicentre randomised controlled trial that compared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits.Methods: Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new model (27 clinics) or the standard model currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment were offered the basic component of the new model, and those deemed at higher risk received the usual care for their conditions; however, all were included in the new-model group for the analyses, which were by intention to treat. The primary outcomes were low birthweight (<2500 g), pre-eclampsia/eclampsia, severe postpartum anaemia (<90 g/L haemoglobin), and treated urinary-tract infection. There was an assessment of quality of care and an economic evaluation.Findings: Women attending clinics assigned the new model (n=12568) had a median of five visits compared with eight within the standard model (n=11958). More women in the new model than in the standard model were referred to higher levels of care (13.4% vs 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates of low birthweight (new model 7.68% vs standard model 7.14%; stratified rate difference 0.96 [95% CI -0.01 to 1.92]), postpartum anaemia (7.59% vs 8.67%; 0.32), and urinary-tract infection (5.95% vs 7.41%; -0.42 [-1.65 to 0.80]). For pre-eclampsia/eclampsia the rate was slightly higher in the new model (1.69% vs 1.38%; 0.21 [-0.25 to 0.67]). Adjustment by several confounding variables did not modify this pattern. There were negligible differences between groups for several secondary outcomes. Women and providers in both groups were, in general, satisfied with the care received, although some women assigned the new model expressed concern about the timing of visits. There was no cost increase, and in some settings the new model decreased cost.Interpretations: Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented without major resistance from women and providers and may reduce cost. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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