Trimester of dating served as a proxy for when they initiated care. Women were eligible if they delivered a pregnancy during the study period and had pregnancies dated by first or second trimester ultrasound at our institution or another institution with an available report. Institutional review board approval was obtained from Washington University School of Medicine.
This was a retrospective cohort study of all consecutive women who were admitted to the Barnes Jewish Hospital Labor and Delivery unit from 2004-2008. When a low-risk woman exceeds this critical point, she is potentially exposed to additional testing which possibly leads to unnecessary interventions.
We posit that prenatal care, in its most basic form, is a surveillance system for low-risk women that works well up to a certain threshold. We hypothesized that low-risk women with high prenatal care utilization would be more likely to have pregnancy interventions, such as induction of labor and cesarean delivery, with no commensurate improvement in neonatal outcomes. We studied the associations between rates of prenatal visit utilization and pregnancy outcomes in a low-risk population who delivered at term. 9 These numbers suggest more PNV may not necessarily mean better outcomes. 8 For example, the median number of PNV in the United States is 11 compared to 7 in France yet, the infant mortality rate in France is 3.1/1000 while it is 6.1/1000 in the United States. Many European countries generally have fewer prenatal visits (PNV) with better birth outcomes compared to the United States. 3 However, available data do not show whether this schedule, or any other prenatal visit schedule, is adequate to improve maternal and neonatal outcomes. 7 Historically, back-loading the majority of visits in the third trimester was done to detect maternal signs and symptoms of preeclampsia. The current recommended American Congress of Obstetrics and Gynecology (ACOG) prenatal visit schedule for uncomplicated first pregnancies consists of a visit every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and weekly until delivery. reduced prenatal visit (PNV) care groups, but low- and middle-income countries had significantly higher rates of perinatal mortality in women with a reduced PNV schedule. More recently, a Cochrane Review found that, in high income countries, there were no differences in perinatal mortality between women randomized to higher vs.
Care during pregnancy doctor visits trial#
A randomized trial of randomized 2764 low-risk women comparing routine care to the reduced USPHS prenatal visit schedule found an average of 2.7 fewer visits in the experimental group without a significant increase in preeclampsia, cesarean delivery, low birth weight or patient satisfaction.
1, 2 The United States Public Health Service (USPHS) convened a multidisciplinary panel in 1989, the Expert Panel on the Content of Prenatal Care, 1 which called for a reduced prenatal visit schedule for healthy, low-risk women based on expert opinion and a review of the literature. Prenatal care in the United States is widely accepted as an important public health intervention yet, its efficacy remains largely unstudied and unproven.
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