Moore T R, Origel W, Key T C, Resnik R
Am J Obstet Gynecol. 1986 Jan;154(1):29-33. doi: 10.1016/0002-9378(86)90387-x.
Reductions in publicly funded prenatal care programs in 1981 to 1984 resulted in an increase in unregistered patient deliveries from 7.8% to 14.9% of births at University of California San Diego Medical Center. To assess the economic and perinatal impact of the increasing number of deliveries of women without prenatal care, 100 consecutive patients with fewer than three prenatal visits were studied. Each "no care" patient was matched by age, parity, and week of delivery with a control patient who received care in a state-funded perinatal project (Comprehensive Perinatal Program). Maternal antenatal risk factors were equally distributed between the two groups when maternal age, parity, history of substance abuse, prior preterm delivery, hypertension, and abortion were compared. Maternal obstetric outcomes were similar, including cesarean section rate and incidence of postpartum fever and hemorrhage. However, neonates delivered of women receiving no care experienced significantly greater morbidity than the neonates of women in the Comprehensive Perinatal Program, including an increased incidence of premature rupture of the membranes and preterm delivery (13% versus 2%, p less than 0.05), low birth weight (21% versus 6% less than 2500 gm, p less than 0.002), and intensive care unit admissions (24% versus 10%, p less than 0.005). When the total inpatient hospital charges were tabulated for each mother-baby pair, the cost of perinatal care for the group receiving no care ($5168 per pair) was significantly higher than the cost for patients in the Comprehensive Perinatal Program ($2974 per pair, p less than 0.001) including an antenatal charge of $600 in the Comprehensive Perinatal Program. The excess cost for delivery of 400 women receiving no care per year in the study hospital was $877,600. These results suggest that extension of prenatal care programs to medically indigent women is likely to result in a net reduction in perinatal morbidity and health care expenditures.
1981年至1984年公共资助的产前护理项目减少，导致加利福尼亚大学圣地亚哥分校医学中心未登记产妇分娩比例从7.8%增至14.9%。为评估未接受产前护理的产妇分娩数量增加对经济和围产期的影响，对100例产前检查少于三次的连续产妇进行了研究。每例“无护理”产妇均按年龄、产次和分娩孕周与在州资助的围产期项目（综合围产期项目）中接受护理的对照产妇进行匹配。比较产妇年龄、产次、药物滥用史、既往早产史、高血压和流产史时，两组产妇的产前危险因素分布相同。产妇的产科结局相似，包括剖宫产率、产后发热和出血发生率。然而，未接受护理的产妇所生新生儿的发病率明显高于综合围产期项目中产妇所生新生儿，包括胎膜早破和早产发生率增加（13%对2%，p<0.05）、低出生体重（21%对6%，低于2500克，p<0.002）以及重症监护病房收治率增加（24%对10%，p<0.005）。将每对母婴的住院总费用列表时，未接受护理组的围产期护理费用（每对5168美元）明显高于综合围产期项目患者的费用（每对2974美元，p<0.001），其中综合围产期项目的产前费用为600美元。研究医院每年400例未接受护理的产妇分娩的额外费用为877,600美元。这些结果表明，将产前护理项目扩展至医疗贫困妇女可能会使围产期发病率和医疗保健支出净减少。
