Abstract
BackgroundCurrent measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care.MethodsThe Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from 'Inadequate' (both tools) to 'Adequate plus' (APNCU) or 'Appropriate' (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools.ResultsAccording to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as 'Adequate' or 'Adequate plus' by the APNCU were deemed 'Inadequate' by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care.ConclusionsThe CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as 'Inappropriate'. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure.
Highlights
Current measures of antenatal care use are limited to initiation of care and number of visits
We looked at the evidence for the following commonly used measures and interventions in pregnancy: evaluation of weight gain; fundal health measurement; routine urine testing for glucose and proteinurea; blood pressure measurement; ultrasound screening for gestational age and for fetal abnormalities; blood tests for anaemia, and for maternal infections that can be transmitted to the fetus/ baby
Thorsdottir et al [24] demonstrated that evaluation of weight gain during pregnancy can be a predictor of preterm birth, birth weight, macrosomia, large for gestational age babies and small for gestational age (SGA) babies
Summary
Current measures of antenatal care use are limited to initiation of care and number of visits. The term ‘adequacy of care’ is not uniformly defined It can include the number of visits [2,9,10], initiation of care [11,12,13] or continuity of health care provider [14,15]. The most currently-used indices are the Adequacy of Prenatal Care Index (APNCU) [16,17] and the Graduated Index of Prenatal care Utilization (GINDEX) [18,19] In both indices, ‘adequate care’ is defined by the number of consultations adjusted for month when care began and the expected number of visits, adjusted for gestational age at delivery
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