Alternative versus standard packages of antenatal care for low-risk pregnancy.

Research output: Contribution to journalReview articlepeer-review

Standard

Alternative versus standard packages of antenatal care for low-risk pregnancy. / Dowswell, Therese; Carroli, Guillermo; Duley, Lelia; Gates, Simon; Gülmezoglu, A. Metin; Khan-Neelofur, Dina; Piaggio, Gilda Gp.

In: Cochrane database of systematic reviews (Online), No. 10, 01.12.2010.

Research output: Contribution to journalReview articlepeer-review

Harvard

Dowswell, T, Carroli, G, Duley, L, Gates, S, Gülmezoglu, AM, Khan-Neelofur, D & Piaggio, GG 2010, 'Alternative versus standard packages of antenatal care for low-risk pregnancy.', Cochrane database of systematic reviews (Online), no. 10.

APA

Dowswell, T., Carroli, G., Duley, L., Gates, S., Gülmezoglu, A. M., Khan-Neelofur, D., & Piaggio, G. G. (2010). Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane database of systematic reviews (Online), (10).

Vancouver

Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D et al. Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane database of systematic reviews (Online). 2010 Dec 1;(10).

Author

Dowswell, Therese ; Carroli, Guillermo ; Duley, Lelia ; Gates, Simon ; Gülmezoglu, A. Metin ; Khan-Neelofur, Dina ; Piaggio, Gilda Gp. / Alternative versus standard packages of antenatal care for low-risk pregnancy. In: Cochrane database of systematic reviews (Online). 2010 ; No. 10.

Bibtex

@article{c87eff6cb05e462b84358174c5bd63f5,
title = "Alternative versus standard packages of antenatal care for low-risk pregnancy.",
abstract = "The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation. To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010), reference lists of articles and contacted researchers in the field. Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care. Two authors assessed trial quality and extracted data independently. We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more 'goal oriented'.Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1.32). Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02). There were no clear differences between the groups for the other reported clinical outcomes.Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs. In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.",
author = "Therese Dowswell and Guillermo Carroli and Lelia Duley and Simon Gates and G{\"u}lmezoglu, {A. Metin} and Dina Khan-Neelofur and Piaggio, {Gilda Gp}",
year = "2010",
month = dec,
day = "1",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "Cochrane Collaboration",
number = "10",

}

RIS

TY - JOUR

T1 - Alternative versus standard packages of antenatal care for low-risk pregnancy.

AU - Dowswell, Therese

AU - Carroli, Guillermo

AU - Duley, Lelia

AU - Gates, Simon

AU - Gülmezoglu, A. Metin

AU - Khan-Neelofur, Dina

AU - Piaggio, Gilda Gp

PY - 2010/12/1

Y1 - 2010/12/1

N2 - The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation. To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010), reference lists of articles and contacted researchers in the field. Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care. Two authors assessed trial quality and extracted data independently. We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more 'goal oriented'.Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1.32). Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02). There were no clear differences between the groups for the other reported clinical outcomes.Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs. In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.

AB - The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation. To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010), reference lists of articles and contacted researchers in the field. Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care. Two authors assessed trial quality and extracted data independently. We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more 'goal oriented'.Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1.32). Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02). There were no clear differences between the groups for the other reported clinical outcomes.Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs. In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.

UR - http://www.scopus.com/inward/record.url?scp=84855460576&partnerID=8YFLogxK

M3 - Review article

C2 - 20927721

AN - SCOPUS:84855460576

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 10

ER -