The Costs of Alternative Types of Routine Antenatal Care for Low-Risk Women: Shared Care Vs Care by General Practitioners and Community Midwives

Objectives: To compare the costs to the health service, women and their families of routine antenatal care provided by either traditional obstetrician-led shared care or general practitioner (GP)/community midwife care. Method: A multicentre randomized controlled trial in 51 general practices linked to nine maternity hospitals in Scotland: 1667 low-risk pregnant women provided information on costs to the health service. 704 of these women provided information on non-health service costs. Results: GP/midwife antenatal care was found to cost statistically significantly less than shared care. This was the case for investigations carried out at routine antenatal visits (GP/midwife = £87.25, shared care = £91.15, P = 0.05), staffing costs at routine antenatal visits (GP/midwife = £127.76, shared care = £131.09, P = 0.001), and non-health service costs incurred by women and their companions (GP/midwife = £118.53, shared care = £133.49, P = 0.001). While non-routine care in the GP/midwife arm of the trial costs less than in the shared care arm, the difference was not statistically significant (GP/midwife = £83.74, shared care = £94.43, P = 0.46). The total societal cost of antenatal care was £417.28 per woman in the GP/midwife arm of the trial and £450.19 in the shared care arm of the trial. This difference was statistically significant ( P < 0.001). The application of sensitivity analysis did not change these results. Conclusions: GP/midwife antenatal care is a satisfactory option for low-risk pregnant women in Scotland provided that clinical outcomes and women's satisfaction are at least the same as those of women with shared care.

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An Economic Evaluation Comparing Two Schedules of Antenatal Visits

Journal of Health Services Research & Policy ◽

10.1177/135581960000500203 ◽

2000 ◽

Vol 5 (2) ◽

pp. 69-75 ◽

Cited By ~ 15

Author(s):

Jane Henderson ◽

Tracy Roberts ◽

Jim Sikorski ◽

Jennifer Wilson ◽

Sarah Clement

Keyword(s):

Economic Evaluation ◽

Health Service ◽

Antenatal Care ◽

Controlled Trial ◽

Low Risk ◽

Sensitivity Analyses ◽

Uk National Health Service ◽

Randomised Controlled ◽

The Uk ◽

Antenatal Visits

Objectives: To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. Methods: Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This took place between 1993 and 1994 in antenatal clinics in South East London and involved 2794 women at low risk of complications. Results: The estimated baseline costs to the UK National Health Service (NHS) for the traditional schedule were £544 per woman, of which £251 occurred antenatally, with a range of £327–1203 per woman. The estimated baseline costs to the NHS for the reduced visit schedule was £563 per woman, of which £225 occurred antenatally, with a range of £274–1741 per woman. Savings from new style care that arose antenatally were offset by the greater numbers of babies in this group who required special or intensive care. Sensitivity analyses based on possible variations in unit costs and resource use and modelled postnatal stay showed considerable variation and substantial overlap in costs. Conclusions: Patterns of antenatal care involving fewer routine visits for women at low risk of complications are unlikely to result in savings to the Health Service. In addition, women who had the reduced schedule of care reported greater dissatisfaction with their care and poorer psychosocial outcomes which argues against reducing numbers of antenatal visits.

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Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians

BMJ ◽

10.1136/bmj.312.7030.554 ◽

1996 ◽

Vol 312 (7030) ◽

pp. 554-559 ◽

Cited By ~ 59

Author(s):

J S Tucker ◽

M H Hall ◽

P W Howie ◽

M E Reid ◽

R S Barbour ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Antenatal Care ◽

General Practitioners ◽

Controlled Trial ◽

Shared Care ◽

Randomised Controlled ◽

Routine Antenatal Care

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Pilates for Low Risk Pregnant Women: Study Protocol for a Randomized Controlled Trial

Journal of Bodywork and Movement Therapies ◽

10.1016/j.jbmt.2020.12.015 ◽

2020 ◽

Author(s):

Melissa Mazzarino ◽

Debra Kerr ◽

Meg E. Morris

Keyword(s):

Randomized Controlled Trial ◽

Pregnant Women ◽

Study Protocol ◽

Controlled Trial ◽

Low Risk ◽

Randomized Controlled

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The Effect of Counselling Intervention during Antenatal Care on the Knowledge and Attitude about Danger Signs in Pregnancy: A Cross-Sectional Study in Takalar Regency -

Journal of Pharmacy and Nutrition Sciences ◽

10.29169/1927-5951.2020.10.02.2 ◽

2020 ◽

Vol 10 (2) ◽

pp. 51-55

Author(s):

Nurhikmah ◽

Tahir Abdullah ◽

Stang ◽

Suriah ◽

Andi Imam Arundhana ◽

...

Keyword(s):

Health Service ◽

Antenatal Care ◽

Pregnant Women ◽

Community Health ◽

Health Workers ◽

Community Health Service ◽

Cross Sectional ◽

Danger Signs ◽

Knowledge And Attitude ◽

In Pregnancy

Objective: This study was to examine the effects of counselling delivered during antenatal care on the knowledge and attitudes of pregnant women about danger signs in pregnancy.Methods: This was a pre-experimental design using one group pre- and post-test only. This study was conducted in Takalar, specifically within Sanrobone Community Health Service working area. Takalar is located in South Sulawesi Province Indonesia and this area is coastal with the majority of people working as a fisherman. Participants of this study were pregnant women living in the villages which are included in the working area of Sanrobone Community Health Service.Results: The study shows that counselling improved knowledge and attitude of pregnant women about danger signs in pregnancy (p=0.011 and p=0.025, respectively). The number of pregnant women with good knowledge and positive attitude increased after the intervention (43.8% vs 93.8%, 62.5% vs 93.8%, respectively).Conclusions: In can be concluded that intervention by means of counselling can improve the knowledge and attitude of pregnant women about danger signs in pregnancy. Therefore, it is important to implement the counselling program delivered by health workers in Community Health Service in order to mitigate the risk of maternal mortality.

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Effect of utilizing developed gestational diabetes mellitus guideline on pregnancy and childbirth outcomes

Clinical Nursing Studies ◽

10.5430/cns.v9n1p15 ◽

2020 ◽

Vol 9 (1) ◽

pp. 15

Author(s):

Enas Sabry Fathy Elbeltagy ◽

Nahed Fikry Hassan Khedr ◽

Nadia Youssef Ahmed Abd-Ella

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Antenatal Care ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Lifestyle Changes ◽

Neonatal Complications ◽

Pregnancy And Childbirth ◽

Routine Antenatal Care

Background: Gestational Diabetes Mellitus (GDM) is one of the most common medical health problems that may happen during pregnancy and may lead to a range of short and long-term maternal, fetal as well as neonatal complications. However, effective management and education on GDM self-care measures improve pregnancy outcomes for both women and their neonates.Aim: The study was carried out to evaluate the effect of utilizing developed gestational diabetes mellitus guideline on pregnancy and childbirth outcomes.Methods: A quasi-experimental research design was used at Antenatal Clinic of Obstetric and Gynecological Specialty Center at Mansoura University Hospitals, Mansoura city. A purposive sample of 126 pregnant women diagnosed with GDM, assigned to the intervention group (n = 63) who utilized the Gestational Diabetes Mellitus Guideline (GDMG) of care in addition to routine antenatal care and control group (n = 63) who followed routine antenatal care only. Tools: Three tools were used to collect data from participants as A structured interview schedule, maternal assessment record and fetal & neonatal assessment record.Results: The current study findings indicated that, there was a highly statistical significant reduction of body mass index and the mean random blood glucose levels at 34 & 37 weeks’ of pregnancy after intervention in the GDMG group than control groups (p < .001). Also, there was a statistical significant reduction in the occurrence of maternal complications as gestational hypertension, preeclampsia, preterm labor and polyhydramnios in the GDMG group .Similarly, the neonates of the GDMG group had better Apgar scores after birth & lower incidence for developing neonatal complications as prematurity, respiratory distress syndrome and NICU admission.Conclusions and Recommendations: This study showed that, pregnant women with GDM who utilized the GDMG had better maternal & neonatal outcomes than those who did not utilize it. It is recommended to provide a manual GDMG to all pregnant women with GDM for better lifestyle changes & maintaining self-management regimen as well as better pregnancy outcomes.

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Current practice and attitudes towards vaccination during pregnancy: a survey of GPs across England

British Journal of General Practice ◽

10.3399/bjgp20x708113 ◽

2020 ◽

Vol 70 (692) ◽

pp. e179-e185

Author(s):

Christopher R Wilcox ◽

Paul Little ◽

Christine E Jones

Keyword(s):

Antenatal Care ◽

Influenza Vaccination ◽

Pregnant Women ◽

Odds Ratio ◽

Online Survey ◽

Current Practice ◽

Optimal Location ◽

Further Education ◽

Survey Questionnaire ◽

Routine Antenatal Care

BackgroundAntenatal vaccines are commonly delivered in primary care, yet the views of GPs regarding these programmes have been neglected in research to date.AimTo establish the attitudes and current practice of GPs towards antenatal vaccination and their views on the optimal location for delivery of this service.Design and settingA multicentre online survey questionnaire.MethodA questionnaire was sent to GPs across England between December 2018 and January 2019.ResultsThe majority of 1586 responders considered antenatal vaccination safe (96% for influenza, 89% pertussis). GPs were significantly less confident in their knowledge of pertussis compared with influenza vaccination (64% versus 80% were confident, P<0.001), and many desired further education (59% versus 48%, P<0.001). Few (37%) discussed vaccination with pregnant women regularly, but most (80%) felt their recommendation would influence decision making. Those with greater confidence in their knowledge of pertussis and influenza vaccination, and who were >2 years since qualifying, discussed vaccination significantly more often (odds ratio [OR] 3.52, P<0.001; OR 2.34, P = 0.001; OR 1.76, P = 0.003, respectively), regardless of whether they routinely saw pregnant women. Most (83%) reported that antenatal vaccination was GP led in their region, yet only 26% thought it should be primarily GP based. GPs expressed disconnect from antenatal care, and many suggested that midwives and/or secondary care should take greater responsibility for the delivery of antenatal vaccination.ConclusionThere is support among GPs to embed vaccination programmes within routine antenatal care. Further educational resources, specifically designed for the needs of GPs, are needed to facilitate opportunistic discussion with pregnant women about vaccination.

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The value of routine mid-trimester ultrasound in low-risk pregnancies at primary care level

Health SA Gesondheid ◽

10.4102/hsag.v13i4.403 ◽

2008 ◽

Vol 13 (4) ◽

pp. 41-49 ◽

Cited By ~ 1

Author(s):

B Van Dyk ◽

JA Motto ◽

EJ Buchmann

Keyword(s):

Antenatal Care ◽

Low Birthweight ◽

Controlled Trial ◽

Open Cluster ◽

Mode Of Delivery ◽

Low Risk ◽

Control Group ◽

Ultrasound Scan ◽

Second Trimester ◽

Ultrasound Scanning

This study investigated the effect of routine second-trimester ultrasound scanning on obstetric management and pregnancy outcomes. This was an open cluster, randomised, controlled trial. Clusters of women with low-risk pregnancies presenting in the second trimester were randomised to receive an ultrasound scan followed by usual antenatal care, or to an unscanned control group undergoing conventional antenatal care only. Out of the 962 women randomised, follow-up was successful for 804 (83.6%), with 416 allocated to the ultrasound scan group and 388 controls. There were no significant differences between the ultrasound scan group and the control group in terms of prenatal hospitalisation, mode of delivery, miscarriage, perinatal mortality rate and low birthweight rate. Ultrasound dating was associated with a lower rate of induction of labour for post-term pregnancy (1.4% vs. 3.6%; P=0.049). However, ultrasound scanning in low-risk pregnancies was not associated with improvements in pregnancy outcome. Opsomming Hierdie studie het die effek van roetine mid-trimester ultraklankskandering op swangerskapsorg en –uitkomste ondersoek. Dit was ’n oop tros, lukrake, beheerde proef. Groepe vroue met laerisikoswanger- skap in die midtrimester is lukraak toegewys vir ’n ultraklank-skandering, gevolg deur voorgeskrewe voorgeboor-tesorg, of vir ’n kontrolegroep wat voorgeboortesorg volgens nasionaal voorgeskrewe protokol sonder skandering ontvang het. Van die 962 vroue wat aan die steekproef deelgeneem het kon data vir 804 (83.6%) suksesvol opgevolg word, met 416 in die ultraklankgroep en 388 in die kontrolegroep. Geen beduidende verskille is tussen die twee groepe gevind ten opsigte van voorgeboorte-hospitalisasie, geboortemetode, miskraamstatistiek, perinatale komplikasies of laegeboortegewig nie. Ultraklankdatering van swangerskappe is met minder kraaminduksie (1.4% teen 3.6%; P=0.049) vir natrimesterswangerskap geassosieer. Roetine ultraklankskandering in laerisikoswangerskap het egter geen verbetering in swangerskapsuitkomste te weeg gebring nie.

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