EFFECTIVENESS OF ANTENATAL CARE - A POPULATION-BASED STUDY

Objective To analyse the effectiveness of antenatal care as a screenin g for nonsymptomatic disease and obstetrical risk conditions. Design P rogramme evaluation of antenatal care in a geographically based cohort . Setting Routine clinical practice in primary and specialist level of health care without intervention. Subjects One thousand nine hundred and eight women residing in one Norwegian county giving birth during a 12 month period, 1988 to 1989. Outcome measures The detection rates a t the time of delivery, for women with five conditions: twin pregnanci es, placenta praevia, breech presentation, small for gestational age ( SGA) and pre-eclampsia. Results Two hundred and ninety-two women had o ne or more of the actual conditions, 124 (42%) had been diagnosed at t he time of the delivery. The detection rate for SGA was remarkably low (14%). The detection rates for pre-eclampsia (75%), breech presentati on (69%), placenta praevia (57%) and twin pregnancies (94%) were in th e same range as results reported in the literature. The number of fals e positive antenatal diagnosis was insignificant. Conclusions Assessin g the effectiveness of antenatal diagnosis of growth retardation is co nnected with major unsolved methodological problems. Clinical manageme nt of such cases may be better than indicated by the results based on the ultimate SGA classification. For important obstetrical conditions this study describes an applicable method for practical evaluation of the effectiveness of antenatal care. Areas where care could be improve d are demonstrated.