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
; 312(7030): 554-9, 1996 Mar 02.
Article
en En
| MEDLINE
| ID: mdl-8595287
ABSTRACT
OBJECTIVE:
To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care.DESIGN:
Multicentre randomised controlled trial.SETTING:
51 general practices linked to nine Scottish maternity hospitals.SUBJECTS:
1765 women at low risk of antenatal complications. INTERVENTION Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications. MAIN OUTCOMEMEASURES:
Comparisons of health service use, indicators of quality of care, and women's satisfaction.RESULTS:
Continuity of care was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6).CONCLUSION:
Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Atención Prenatal
/
Medicina Familiar y Comunitaria
/
Ginecología
/
Partería
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Guideline
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Pregnancy
País/Región como asunto:
Europa
Idioma:
En
Revista:
BMJ
Asunto de la revista:
MEDICINA
Año:
1996
Tipo del documento:
Article