Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Comentary: routine antenatal visits for healthy pregnant women do make a difference

G Justus Hofmeyr,Ellen D Hodnett

doi:10.1186/1742-4755-10-20

Abstract

The practice and timing of routine antenatal visits for healthy pregnant women, introduced arbitrarily and without evidence of effectiveness, have become entrenched in obstetric practice over the last century. In 2001 the large, cluster randomized WHO Antenatal Care Trial concluded that a goal-orientated package of antenatal care with reduced visits seemed not to affect maternal and perinatal outcomes. The reduced visit package has been implemented in several countries. The current re-analysis finds that the significantly increased perinatal mortality which occurred in the reduced visit package persists after adjustment for potential confounding factors. The WHO Antenatal Care Trial provided the first evidence from a randomized trial that the traditional high frequency of routine visits in the third trimester may well reduce perinatal mortality.

Highlights

The practice and timing of routine antenatal visits for healthy pregnant women, introduced arbitrarily and without evidence of effectiveness, have become entrenched in obstetric practice over the last century
Routine antenatal care visits for healthy pregnant women were introduced in Europe [1] and North America [2] almost a century ago on the unproven assumption that they would improve outcomes for mother and baby
Perinatal mortality was increased in the reduced visit package (234/11672, 2.0% versus 190/ 11121, 1.7%), the conclusion arrived at by the authors was

Summary

Introduction

The practice and timing of routine antenatal visits for healthy pregnant women, introduced arbitrarily and without evidence of effectiveness, have become entrenched in obstetric practice over the last century. Routine antenatal care visits for healthy pregnant women were introduced in Europe [1] and North America [2] almost a century ago on the unproven assumption that they would improve outcomes for mother and baby. The practice has become so entrenched that randomized trials of antenatal care versus no antenatal care are unlikely to be undertaken.

Results

Conclusion