Consequences of programme changes in antenatal care

Abstract: Routine antenatal care includes a number of routine contacts, in Sweden mostly with a midwife but with one visit to a physician. A reduction of the scheduled visits by 4-5 was assessed with retrospective data from the year before and the year after the programme change in 1991.The effective reduction was 1.8 visits per pregnancy since the need for extra contacts-increased. Severe hypertension, preeclampsia and malpresentation were diagnosed to the same extent and risk pregnancies had similar surveillance. The predictive value of risk assessment in early pregnancy was low for complications during pregnancy and risk status at the end of pregnancy. The possibility to predict unexpected complications duringdelivery was also poor irrespective of the amount of antenatal contacts.In a randomised controlled trial a planning conference with midwife and physician was compared to the routine doctor's examination early in pregnancy. Doctor's consultations decreased by 70%. The need for extra visits in the first half of pregnancy increased by 5% but the practical impact was negligible. Need for referrals or interventions later in pregnancy was not influenced by the new routine.Reducing the routine surveillance programme resulted in less work load within the health care and had no adverse effects on diagnostic safety or risk prediction. With more consultations performed only on indication time could be directed to mothers with special needs.