WHO systematic review of randomised controlled trials of routine antenatal care.
Background: There is a lack of strong evidence on the effectiveness of the content, frequency, and timing of visits in standard antenatal-care programmes. We undertook a systematic review of randomised trials assessing the effectiveness of different models of antenatal care. The main hypothesis was...
| Published in: | Lancet Vol. 357; no. 9268; pp. 1565 - 1571 |
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| Main Authors: | , , , , , , , , , , , , , , , , , |
| Format: | research systematic review tables/charts Journal Article |
| Published: |
Lancet
5/19/2001
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107076618&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107076618 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: 107076618 107076618 NLM11377643 2001113925 10.1016/s0140-6736(00)04723-1 NLM11377643 107076618 ppf: 1565 ppct: 6 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: WHO systematic review of randomised controlled trials of routine antenatal care. aug: au: Carroli G Villar J Piaggio G Khan-Neelofur D Gülmezoglu M Mugford M Lumbiganon P Farnot U Bersgjø P Carroli, G Villar, J Piaggio, G Khan-Neelofur, D Gülmezoglu, M Mugford, M Lumbiganon, P Farnot, U Bersgjø, P affil: Centro Rosarino de Estudios Perinatales, Pueyrredon 985, 2000, Rosario, Argentina sug: subj: Pregnancy Complications Prevention and Control Prenatal Care Methods Female Human Maternal Welfare Meta Analysis Office Visits Pregnancy Prenatal Care Utilization Randomized Controlled Trials Female ab: Background: There is a lack of strong evidence on the effectiveness of the content, frequency, and timing of visits in standard antenatal-care programmes. We undertook a systematic review of randomised trials assessing the effectiveness of different models of antenatal care. The main hypothesis was that a model with a lower number of antenatal visits, with or without goal-oriented components, would be as effective as the standard antenatal-care model in terms of clinical outcomes, perceived satisfaction, and costs.Methods: The interventions compared were the provision of a lower number of antenatal visits (new model) and a standard antenatal-visits programme. The selected outcomes were pre-eclampsia, urinary-tract infection, postpartum anaemia, maternal mortality, low birthweight, and perinatal mortality. We also selected measures of women's satisfaction with care and cost-effectiveness. This review drew on the search strategy developed for the Cochrane Pregnancy and Childbirth Group of the Cochrane Collaboration.Findings: Seven eligible randomised controlled trials were identified. 57418 women participated in these studies: 30799 in the new-model groups (29870 with outcome data) and 26619 in the standard-model groups (25821 with outcome data). There was no clinically differential effect of the reduced number of antenatal visits when the results were pooled for pre-eclampsia (typical odds ratio 0.91 [95% CI 0.66-1.26]), urinary-tract infection (0.93 [0.79-1.10]). postpartum anaemia (1.01), maternal mortality (0.91 [0.55-1.51]), or low birthweight (1.04 [0.93-1.17]). The rates of perinatal mortality were similar, although the rarity of the outcome did not allow formal statistical equivalence to be attained. Some dissatisfaction with care, particularly among women in more developed countries, was observed with the new model. The cost of the new model was equal to or less than that of the standard model.Interpretation: A model with a reduced number of antenatal visits, with or without goal-oriented components, could be introduced into clinical practice without risk to mother or baby, but some degree of dissatisfaction by the mother could be expected. Lower costs can be achieved. pubtype: Academic Journal doctype: research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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