Antenatal Care Program Research Articles

Antenatal care in developing countries: The need for a tailored model

In developed countries, 98% of all women receive prenatal care and 94% give birth under the supervision of skilled healthcare practitioners with timely access to appropriate emergency treatment if complications arise. In contrast, large numbers of pregnant women in Africa and Asia do not receive adequate prenatal care and lack skilled attendance at birth. In developing countries quality of prenatal care is often scarce: models of care adopted in the western world and exported to the developing world have not been monitored early enough to discover their weak points promptly. This blind attitude has transformed antenatal care into an empty and useless ritual, and explains why antenatal care programmes continue to be unsuccessful, being inappropriate to the specific situation. A mix of educational and cultural factors together with persistent lack of resources in a global critical situation all contribute to the poor results of antenatal care programmes. Antenatal care services should be free of charge, planned and implemented within the community, cost-effective, and should yield evidence-based quality care. They should also include information for the patient and family members, provide affordable treatment of existing conditions, and warrant referral for complications.

THE INFLUENCE OF ANTENATAL AND MATERNAL FACTORS ON STILLBIRTHS AND NEONATAL DEATHS IN NEW SOUTH WALES, AUSTRALIA

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2,000 g) contributed 75.6% of the population-attributable risks to stillbirths and 59.4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77.7% of stillbirths and 87.9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study.

Impact of a collaborative shared antenatal care program for urban Indigenous women: a prospective cohort study

To evaluate the impact of a community-based, collaborative, shared antenatal care intervention (the Mums and Babies program) for Indigenous women in Townsville. Prospective cohort study of women attending Townsville Aboriginal and Islander Health Service (TAIHS) for shared antenatal care with a singleton Indigenous birth between 1 January 2000 and 31 December 2003 (456 women; the MB group), compared with a historical control group of 84 women who attended TAIHS for antenatal care before the intervention between 1 January 1998 and 30 June1999, and a contemporary control group of 540 women who had a singleton birth at Townsville Hospital between 1 January 2000 and 30 June 2003, but did not attend TAIHS for antenatal care. Integration of previously autonomous service providers delivering shared antenatal care from TAIHS. Patterns of antenatal visits, proportion of women undertaking key antenatal screening, and perinatal outcomes. The number of Indigenous women who entered the MB program and gave birth at Townsville Hospital rose from 23.8% in 2000 to 61.2% in 2003. The number of antenatal care visits per pregnancy increased from three (interquartile [IQ] range, 2-6) in the historical control group to seven (IQ range, 4-10) in the MB group (P < 0.001). 88% of women in the MB group had at least one ultrasound. About 90% of all women attending for antenatal care were screened for sexually transmitted infections. In the MB group, there was a significant reduction in preterm births compared with the contemporary control group (8.7% v 14.3%, P < 0.01). There was no significant reduction in the prevalence of low birthweight births or perinatal mortality. A community-based collaborative approach to shared antenatal care services increased access to antenatal care and was associated with fewer preterm births among Indigenous women in Townsville. The model may be adaptable in other urban centres with multiple antenatal care providers and significant numbers of Indigenous people across Australia.

Predictores de utilización de la atención prenatal

To establish the association and possible interactions between emotional and cognitive factors in pregnant women and their use of institutional antenatal care. It was assumed that the knowledge and attitude of a pregnant woman determines her approach to demanding antenatal care. Analytic study. Hospitals in the Health Area of Jalisco, Mexico. 2955 women leaving hospital early who had had at least 2 antenatal consultations. Personal and reproductive characteristics of the women, opportunity and continuity of antenatal care, knowledge of pregnancy and the antenatal care programme, attitudes towards institutional medical care of pregnancy. In the logistical regression model, 6 associations or interactions between unsatisfactory antenatal care and the variables analysed were found. The strong association of positive attitudes and sufficient knowledge in achieving satisfactory antenatal care was notable, and was even placed above the question of receiving, or otherwise, free medical provision from the health service. Undoubtedly, women's educational background plays a major role. This obliges the health services to strengthen their educational programmes by adjusting them to women's culture.

Improvement in maternal health literacy among pregnant women who did not complete compulsory education: policy implications for community care services

This paper examined factors that influence the improvement in maternal health literacy among pregnant women in Paraguay, including those who did not complete compulsory education but participated in a community-based antenatal care program. Structured interviews were conducted to evaluate the pregnant women's maternal health literacy during their first, second, and third visits to the program in the Caazapa Region. The associations between individual maternal health knowledge scores and its gains, healthcare personnel capabilities, available health facility equipment, community social network, and living environment were analyzed by multiple regression analysis. The mean maternal health knowledge score from 124 women who completed three-consecutive assessments increased between the first and third interviews. Higher capabilities of healthcare personnel and better living environment were significantly related to gains in the maternal health knowledge score ( p < 0.01). Wider application of a community-based antenatal care program to meet the needs of those who are functionally illiterate in the standard language of the country, training for community healthcare personnel to improve capabilities, and resources for social network in the community would contribute to the improvement in maternal health literacy.

From research to practice: the example of antenatal care in Thailand.

The rationale for providing antenatal care is to screen predominantly healthy pregnant women to detect early signs of, or risk factors for, abnormal conditions or diseases and to follow this detection with effective and timely intervention. The recommended antenatal care programme in most developing countries is often the same as the programmes used in developed countries. However, in developing countries there is wide variation in the proportion of women who receive antenatal care. The WHO randomized trial of antenatal care and the WHO systematic review indicated that a model of care that provided fewer antenatal visits could be introduced into clinical practice without causing adverse consequences to the woman or the fetus. This new model of antenatal care is being implemented in Thailand. Action has been required at all levels of the health-care system, from consumers through to health professionals, the Ministry of Public Health and international organizations. The Thai experience is a good example of moving research findings into practice, and it should be replicated elsewhere to effectively manage other health problems.

Midwives' attitudes to and knowledge about a newly introduced foetal screening method.

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.

Management of Hypertension in Pregnancy as a Quality Indicator of Antenatal Care in Rural Tanzania

To assess the ability of antenatal care to manage hypertension in pregnancy, a cross-sectional study involving 379 pregnant women was conducted in 16 randomly selected antenatal clinics in Rufiji district of Tanzania. We observed necessary structural availability, provider client interaction, interviewed women attending antenatal clinics, and measured their blood pressure. Measurements made by observers and health workers were compared. One third of the women were not checked for hypertension and health workers detected only four out of twelve women with elevated blood pressure. There was disagreement in diagnosis of blood pressure as measured by health workers and observers. Only one woman with elevated blood pressure was managed appropriately. The low quality of screening and management of hypertension in pregnancy makes it less realistic to expect any impact of antenatal care programme in reducing morbidity or mortality due to hypertension in pregnancy.

Influence of socio-economic background and antenatal care programmes on maternal mortality in Surabaya, Indonesia.

To determine the risk factors, such as socio-economic background, quality of antenatal care and availability of family planning, responsible for high maternal mortality in Surabaya, Indonesia. The study used a case-control design. Descriptive, bivariate and multivariate analyses were carried out, comparing 59 maternal deaths and 177 women survivors in the referral hospital, from 1996 to 1999. The risk factors for maternal mortality were: living outside of Surabaya [odds ratio (OR) = 11.7, 95% confidence interval (CI) = 5.0-29.2], unemployment (OR = 4.4, 95% CI = 1.7-13.8), unavailability of toilet facilities (OR = 2.9, 95% CI = 1.0-7.7), <4 antenatal visits (OR = 2.5, 95% CI = 1.1-5.5) and initial visit to antenatal care facilities after the fourth month of pregnancy (OR = 3.0, 95% CI = 1.3-7.0). There was no significant association between maternal mortality and the availability of family planning. Low socio-economic background and the availability of antenatal care have a significant influence on maternal mortality in Surabaya, Indonesia.

Nutritional Interventions during Pregnancy for the Prevention or Treatment of Maternal Morbidity and Preterm Delivery: An Overview of Randomized Controlled Trials

This overview assesses the effectiveness of nutritional interventions to prevent or treat maternal morbidity, mortality and preterm delivery. Cochrane systematic reviews and other up-to-date systematic reviews and individual randomized controlled trials were sought. Searches were carried out up to July 2002. Iron and folate supplements reduce anemia and should be included in antenatal care programs. Calcium supplementation to women at high risk of hypertension during pregnancy or low calcium intake reduced the incidence of both preeclampsia and hypertension. Fish oil and vitamins E and C are promising for preventing preeclampsia and preterm delivery and need further testing. Vitamin A and beta-carotene reduced maternal mortality in a large trial; ongoing trials should provide further evaluation. No specific nutrient supplementation was identified for reducing preterm delivery. Nutritional advice, magnesium, fish oil and zinc supplementation appear promising and should be tested alone or together in methodologically sound randomized controlled trials. Anema in pregnancy can be prevented and treated effectively. Considering the multifactorial etiology of the other conditions evaluated, it is unlikely that any specific nutrient on its own, blanket interventions or magic bullets will prevent or treat preeclampsia, hemorrhage, obstructed labor, infections, preterm delivery or death during pregnancy. The few promising interventions for specific outcomes should be tested or reconsidered when results of ongoing trials become available. Until then, women and their families should receive support to improve their diets as a general health rule, which is a basic human right.

The WHO antenatal care model: the defects

The WHO antenatal care model: the defects

Quality assessment of the antenatal program for anaemia in rural Tanzania.

To assess the quality of antenatal care with respect to anaemia, a common health problem, in a developing country. Cross-sectional study. Rufiji rural district, coastal Tanzania. Three hundred and seventy-nine consecutively enrolled pregnant women from 16 randomly selected antenatal clinics, including 10 dispensaries, four rural health centres and two hospitals. We noted availability of infrastructure for management of anaemia, observed provider-client interaction, and interviewed women who attended antenatal clinics. An observer and health workers measured haemoglobin levels and their measurements were compared. Quality of antenatal care, anaemia in pregnancy, and maternal satisfaction. Half of the rural health clinics had no instrument to measure haemoglobin. The majority (58%) of pregnant women were not checked for anaemia at all, 10% were clinically examined, and 37% had haemoglobin assessed. The agreement between health workers' (using Tallqvist) and the observers' (using HemoCue) measurements of haemoglobin was poor to fair. The prevalence of anaemia (Hb < 10.5 g/dl) and severe anaemia (< 7.0 g/dl) was 58% and 6.2%, respectively, but overall only 4% of the anaemic pregnant women had specific action taken within the antenatal care program. Deficiencies in quality of screening, diagnostic information, and individual counselling need to be addressed before any impact of the antenatal care programme on anaemia can be expected.

Violence against pregnant women will remain hidden as long as no direct questions are asked

Objective: to assess the experience, knowledge, attitudes and routines regarding violence against pregnant women among midwives working at antenatal clinics in the county of Västerbotten, northern Sweden. Design: five qualitative research interviews with midwives were conducted. In addition, questionnaires were sent to all midwives working at the antenatal clinics in the county. Findings: the midwives, although very knowledgeable about and sensitive to pregnant women and their needs, still rarely revealed the occurrence of violence. Symptoms and signals of abuse may vary and are not easily recognised by an outsider. Among pregnant women registered at the antenatal clinic, the midwives roughly estimated that the frequency of known cases of physical and sexual abuse before and during the current pregnancy was 2.3 and 0.6%, respectively for the preceding calendar year. The local programme for antenatal care provided no guidelines regarding response to violence, no instruments for disclosure and no directions about support when confronted with an abused pregnant woman. The midwife did not usually ask any questions if she was merely suspicious but had no strong supporting evidence. In answering the questionnaire however, the midwives were positive towards asking every pregnant woman about abuse in approximately the same way as they asked about other issues already incorporated in the records. Conclusion: most likely the midwives in this study were disclosing only a fraction of the cases of abuse against women. Violence of this kind will probably remain hidden as long as the whole issue of violence is not included in the national recommendations or in the local programme for antenatal care. Implications for practice: there should be specific written recommendations in the national antenatal care programme to guide and support the midwives in questioning all pregnant women about violence. To achieve adequate and optimal assessment and intervention at the antenatal clinic, the midwives need to be given education and training and provided with a supportive professional network both for themselves and for the abused women.

The quality of antenatal care in Turkey and the role of ultrasonography in the antenatal care system.

The aim of this study was to determine the quality of antenatal care and the role of routine obstetric ultrasonography (US) in Turkey's antenatal care program. Two surveys consisting of 11 questions were conducted on 295 patients without pregnancy associated risk in 1995 and on 208 patients in 2000, during the first 24 h after delivery. The results of the two surveys were compared. A P value of <0.05 was used to denote statistical significance. When the results of the two surveys were compared, we found that in 2000, patients had started their antenatal visits earlier in pregnancy than those in 1995 and basic laboratory tests, such as complete blood count, urinalysis, and diabetes screening had been performed on an increased number of patients receiving antenatal care outside our clinic. Ultrasonographic examination was performed on all of the patients during their antenatal visits in 2000, while only 76.6% of the cases were examined by US in 1995. The number of ultrasound examinations per antenatal visit had significantly increased (0.47 in 1995 versus 0.6 in 2000, [Odds ratio: 1.277, 95% confidence interval: 1.12-1.44]). Data from 2000 has shown that 8.7% (5/57) of the patients who received antenatal care outside our clinic (Group 1) had been examined using US at least 10 times. However, 17.5% of these patients had not undergone a complete blood count (CBC) or urinalysis and blood pressure had not been measured at all in 5.2% of cases. Despite some differences, we believe that the situation in Turkey is similar to that in the rest of the world. The expectations women have of ultrasound examination are much higher than can be realised in reality. In Turkey, it appears that many physicians, especially those based in large cities, rely on highly technical procedures like ultrasonography and neglect the basics of antenatal care (blood pressure measurements, complete blood counts, urinalysis, diabetes screening etc.).

Integration of STI Prevention and Management with Family Planning and Antenatal Care in Sub-Saharan Africa: What More Do We Need to Know?

CONTEXT: The high prevalence of sexually transmitted infections (STIs) and their role in HIV transmission have made integrating STI prevention and management into existing family planning and antenatal care programs a goal in most resource-poor countries, especially in Sub-Saharan Africa. However, little is known about how integrated services can best be configured, and what impact they have on prevention of infection and unwanted pregnancy. METHODS: The literature is reviewed to examine what is and is not known about integration and to identify priority areas to be addressed through research. RESULTS: The feasibility and effectiveness of strategies that focus on the addition of either STI prevention services or detection and treatment activities are uncertain. An urgent need for research exists in three areas. The first is the development and testing of strategies that, instead of adding STI-related activities to existing family planning and antenatal care programs, seek to reorient the goals of routine consultations toward protection against the dual risks of unwanted pregnancy and infection and involvement of clients in deciding the outcome of the consultation. Second, strategies that reach male partners and facilitate access by adolescents to sexual and reproductive health services need to be developed and tested. Finally, prospective, preferably randomized studies need to be carried out to test and compare the impact of alternative integration strategies on population-level indicators of behavior and health. CONCLUSIONS: Strategies for integration of services need to be rigorously tested to ensure that they are both feasible and effective before they are implemented. International Family Planning Perspectives, 2002, 28(2):77‐86

Doppler ultrasonography in singleton pregnancies at risk of intrauterine growth retardation-- a national estimate.

In order to assess the organizational and economical implications of Doppler ultrasonography used in high risk pregnancies, a national estimate of the use in singleton pregnancies with risk of small for gestational age (>2 SD below mean birthweight) (SGA) or intrauterine growth retardation (IUGR) was needed. Through retrospective analyzes of both national registry data, and local clinical and ultrasonic records from Copenhagen University Hospital annual populations of singleton pregnant women with suspected IUGR and/or infants born SGA were described. The antenatal care program for assessing pregnancies with suspected IUGR was described. In 1996 2.8% of all singleton infants were born SGA. The population had increased risk of perinatal mortality and morbidity, and about 40% had labor induced or were delivered by caesarean section, compared to 15% of the infants with normal birthweight. In the local population 79 (3.3%) of singleton infants were born SGA and 2/3 of these were considered SGA or IUGR before delivery. Of all singleton pregnancies, a total of 88 (3.7%) were assessed by ultrasonic fetometry because of a risk or clinical suspicion of SGA, and 49 (55.7%) of these pregnancies resulted in a SGA infants. Combining national and local data it is estimated that in Denmark, about 2000 women (3.1%) will be referred for ultrasonic fetometry each year because of a risk or clinical suspicion of SGA and have a mean of 2.5 fetometries. About 75% (1500) will be further assessed by Doppler ultrasonography and have a mean of 3.4 Doppler examinations. The annual number of Doppler ultrasonography examinations in singleton pregnancies with increased risk of or signs of IUGR is estimated to be about 5000.

Patterns of routine antenatal care for low-risk pregnancy.

It has been suggested that reduced antenatal care packages or prenatal care managed by providers other than obstetricians for low risk women can be as effective as standard models of antenatal care. The objective of this review was to assess the effects of antenatal care programmes for low-risk women. We searched the Cochrane Pregnancy and Childbirth Group trials register, reference lists of articles and we also contacted researchers in the field. Date of last search: April 1999. Randomised trials comparing programmes of antenatal care with varied frequency and timing of the visits and different types of care providers. Trial quality was assessed and data were extracted by two reviewers independently. Study authors were contacted for additional information and they were provided with the final version of the review. Nine trials involving over 25000 women were included. Six trials evaluated the number of visits and three trials evaluated the type of care provider. Most trials were of acceptable quality. Moderate reduction in the number of visits was not associated with an increase in any of the negative perinatal outcomes reviewed. However, trials from developed countries suggest that women can be less satisfied with the reduced number of visits and feel that their expectations with care are not fulfilled. Antenatal care provided by a midwife/general practitioner was associated with improved perception of care by women. Clinical effectiveness of midwife/general practitioner managed care was similar to that of obstetrician/gynaecologist led shared care. It appears that a moderate reduction in the number of antenatal care visits with an increased emphasis on the content of the visits could be implemented without any increase in adverse biological perinatal outcomes. Women can be less satisfied with reduced visits. While clinical effectiveness seemed similar, women appeared to be slightly more satisfied with midwife/general practitioner managed care compared to obstetrician/gynaecologist led shared care.

Differing influences on Aboriginal and non-Aboriginal neonatal phenotypes: a prospective study.

To understand the differences, if any, in major influences on birth phenotype between Aboriginal and non-Aboriginal neonates. Prospective study of a cohort of pregnant Aboriginal women presenting for antenatal care before 20 weeks' gestation (ultrasound proven), and a reference cohort of pregnant non-Aboriginal women. Comparison of the phenotypic and demographic characteristics of the women, their pregnancies and their babies. 96 Aboriginal and 96 non-Aboriginal women with no known medical factors affecting fetal growth or gestation. Four remote far north Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital. Neonatal birth weight, length, head circumference, abdominal circumference, mid-arm circumference and triceps skinfold thickness, and derived ponderal index (weight/length3), head:abdomen circumference ratio and head:mid-arm circumference ratio. The Aboriginal neonates were on average almost 450 g lighter than their non-Aboriginal counterparts. They were also slightly shorter, with smaller head, abdomen and mid-arm circumferences and lower mean ponderal indices and triceps skinfold thickness. The gestational characteristics of the two groups were not significantly different. Neonatal phenotype was significantly associated with maternal body mass index and maternal age in both groups. Alcohol use in pregnancy was associated with a significant reduction in Aboriginal neonatal size, while tobacco use was significantly associated with size reductions in non-Aboriginal babies. Culturally appropriate antenatal care programs targeting the effects of poor nutrition and excessive alcohol use are needed if the excess incidence of low birthweight in Aboriginal people is to be reduced.

Community-based antenatal home care programme for the management of preterm premature rupture of membranes

Objective: to determine whether a structured community-based antenatal home care programme for selected patients with spontaneous preterm premature rupture of membranes (SPPROM), providing daily nursing monitoring, patient education, and supported by medical supervisors, is an acceptable alternative to total in-hospital care.Methods: in a retrospective cohort-control study, we compared the profile and outcomes of patients with SPPROM managed in the antenatal home care programme (AHCP) between 1992 and 1996 to a historic control managed by total in-hospital care (HOSP) between 1987 and 1991. Outcome measures included length of latency period, incidence of chorioamnionitis, gestational age at delivery, birth weight, incidence of admission to the neonatal intensive care unit (NICU), and neonatal morbidity. We used regression analyses to determine predictors of selected outcomes.Results: the two cohorts (AHCP, n = 59 and HOSP, n = 54) were not significantly different in gestational age at SPPROM, antenatal antibiotic use, or rates of Group B Streptococcus colonization. Use of corticosteroids was significantly more frequent in the AHCP cohort (44% vs. 22%, p = 0.02). AHCP patients had longer latency duration to delivery (24.6 vs. 12 days, p<0.001), less chorioamnionitis (17% vs. 35%, p = 0.03), more advanced gestational age at delivery (33 vs. 31 weeks, p<0.001), and their newborns had fewer admissions to the neonatal intensive care unit (45% vs. 75%, p = 0.001). Using regression analyses, site of care and gestational age at SPPROM were significant predictors of gestational age at delivery and chorioamnionitis, adjusting for antibiotic use, steroid use, and Group B Streptococcus status.Conclusion: Management of selected patients with SPPROM by a structured community-based antenatal home care programme, rather than total in-hospital care, is feasible and may be associated with improved maternal and neonatal outcomes. Further evaluation by a randomized trial is warranted.

Evaluation of mass antenatal care program of Delhi

International Journal of Gynecology & ObstetricsVolume 70, Issue S4 p. D83-D83 Poster Antenatal care and diagnosis Evaluation of mass antenatal care program of Delhi N. Agarwal, Search for more papers by this authorP. Yadav, Search for more papers by this author N. Agarwal, Search for more papers by this authorP. Yadav, Search for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)84407-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS42000Pages D83-D83 RelatedInformation