Carroli G, Villar J, Piaggio G, Khan-Neelofur D, Gülmezoglu M, Mugford M, Lumbiganon P, Farnot U, Bersgjø P
Centro Rosarino de Estudios Perinatales, Pueyrredon 985, 2000, Rosario, Argentina.
Lancet. 2001 May 19;357(9268):1565-70. doi: 10.1016/S0140-6736(00)04723-1.
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.
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.
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.
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.
关于标准产前护理计划中就诊内容、频率和时间安排的有效性，缺乏有力证据。我们对评估不同产前护理模式有效性的随机试验进行了系统评价。主要假设是，就诊次数较少（无论有无目标导向成分）的模式在临床结局、感知满意度和成本方面与标准产前护理模式同样有效。
比较的干预措施为提供较少的产前就诊次数（新模式）和标准产前就诊计划。选定的结局指标为子痫前期、尿路感染、产后贫血、孕产妇死亡率、低出生体重和围产期死亡率。我们还选取了妇女对护理的满意度及成本效益的衡量指标。本评价采用了为Cochrane协作网的Cochrane妊娠与分娩组制定的检索策略。
确定了7项符合条件的随机对照试验。57418名妇女参与了这些研究：新模式组30799名（29870名有结局数据），标准模式组26619名（25821名有结局数据）。当汇总子痫前期（典型比值比0.91[95%CI 0.66 - 1.26]）、尿路感染（0.93[0.79 - 1.10]）、产后贫血（1.01）、孕产妇死亡率（0.91[0.55 - 1.51]）或低出生体重（1.04[0.93 - 1.17]）的结果时，产前就诊次数减少没有临床差异效应。围产期死亡率相似，尽管该结局罕见，无法实现正式的统计学等效性。新模式存在一些护理方面的不满，尤其是在较发达国家的妇女中。新模式的成本等于或低于标准模式。
就诊次数较少（无论有无目标导向成分）的模式可引入临床实践，对母婴无风险，但母亲可能会有一定程度的不满。可实现更低的成本。
