Villar J, Bergsjø P
Special Programme of Research, Development & Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
Acta Obstet Gynecol Scand. 1997 Jan;76(1):1-14. doi: 10.3109/00016349709047778.
Scope and content of antenatal care programs are ritualistic rather than evidence-based. We wanted to identify elements of antenatal care which are of proven benefit in preventing or ameliorating specific adverse outcomes in the mother: bleeding, anemia, preeclampsia, sepsis and genito-urinary infection and obstructed labor.
Review of recent literature, especially randomized controlled trials.
Recent trials indicate that fewer routine visits for low-risk women do not put pregnancies at increased risk but may lessen patient satisfaction. Bleeding in pregnancy has many causes, none of which can be eliminated through antenatal care. Risk factors can be identified by history-taking. Counselling and advice on what to do is the best option. Anemia in pregnancy is common, especially in developing countries. Routine iron supplementation is not necessary in well-nourished populations, but iron and folate should be provided for every pregnant woman in areas of high anemia prevalence; based on circumstantial evidence. Hemoglobin (Hb) determination as a routine test is more important late (around week 30) than early in pregnancy: high Hb is a danger signal. It is uncertain whether early detection of pre-eclampsia will reduce the incidence of eclampsia. Recent trials do not support routine aspirin to prevent pre-eclampsia among low risk women, nor is there evidence that anti-hypertensive treatment of mild pre-eclampsia will prevent more severe disease, but improved detection and care may still lead to better outcome. As to infections, urine culture and dipstick for leucocyte esterase and nitrite with subsequent treatment of positive cases will reduce the risk of pyelonephritis and appears to be cost-effective. Serological screening and treatment of syphilis is inexpensive and cost-effective. Obstructed labor can be anticipated in multiparas based on obstetrical history. Hospital delivery should be secured. Height of nulliparas should be recorded where hospital birth is not routine and a discriminatory level for hospital delivery decided locally. External version of breech lie does reduce the incidence of breech births and cesarean delivery.
产前护理计划的范围和内容多为惯例性，而非基于证据。我们希望确定产前护理的哪些要素在预防或改善母亲的特定不良结局方面已被证明有益：出血、贫血、先兆子痫、败血症、泌尿生殖系统感染和难产。
回顾近期文献，尤其是随机对照试验。
近期试验表明，低风险女性减少常规产检次数不会增加妊娠风险，但可能会降低患者满意度。孕期出血原因众多，产前护理无法消除任何一种原因。通过病史采集可识别风险因素。提供应对措施的咨询和建议是最佳选择。孕期贫血很常见，尤其是在发展中国家。营养良好的人群无需常规补充铁剂，但在贫血高发地区，应为每位孕妇提供铁剂和叶酸；基于间接证据。血红蛋白（Hb）测定作为一项常规检查，在妊娠晚期（约第30周）比早期更重要：高Hb是一个危险信号。先兆子痫的早期检测是否会降低子痫的发生率尚不确定。近期试验不支持低风险女性常规使用阿司匹林预防先兆子痫，也没有证据表明轻度先兆子痫的降压治疗能预防更严重的疾病，但改进检测和护理仍可能带来更好的结局。至于感染，进行尿培养以及检测白细胞酯酶和亚硝酸盐试纸条，并对阳性病例进行后续治疗，将降低肾盂肾炎的风险，且似乎具有成本效益。梅毒的血清学筛查和治疗成本低廉且具有成本效益。根据产科病史，经产妇可预测难产。应确保在医院分娩。在非常规医院分娩的地区，应记录初产妇的身高，并在当地确定医院分娩的判别标准。臀位外倒转术确实可降低臀位分娩和剖宫产的发生率。
