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Obstetrical & Gynecological Survey May 2024Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best... (Review)
Review Comparative Study
IMPORTANCE
Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes.
OBJECTIVE
The aim of this study was to review and compare the most recently published guidelines on antenatal care.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted.
RESULTS
There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage.
CONCLUSIONS
Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.
Topics: Humans; Pregnancy; Female; Prenatal Care; Practice Guidelines as Topic; Canada; Australia; New Zealand
PubMed: 38764206
DOI: 10.1097/OGX.0000000000001261 -
Revista Latino-americana de Enfermagem Jul 2019to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy. (Comparative Study)
Comparative Study
OBJECTIVE
to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy.
METHOD
this is a cohort study, conducted with an intentional sample of 273 mothers/babies from the neonatal period and followed up for one year. Donabedian evaluation was adopted and data were discussed based on the Social Determination of Health. The independent variable was the care model. The dependent variables in the process evaluation were related to the quality of prenatal care and to the quality score created and the evaluation of the outcome, to the conditions of birth and the first year of life. The evaluation of the process was performed by estimating the relative risk and the evaluation of the outcome was performed by the Cox Multiple Regression Model.
RESULTS
lower income and risk of the low prenatal quality score were identified in the Family Health Units, where there were more puerperium consultation and health education actions. There was no difference in outcome indicators.
CONCLUSION
possibly the best quality of prenatal care was able to minimize negative socioeconomic effects found in family health, so the outcome indicators were similar in both models of the primary care.
Topics: Brazil; Child Health; Family Health; Female; Humans; Prenatal Care; Primary Health Care; Program Evaluation; Prospective Studies; Quality Indicators, Health Care; Socioeconomic Factors; Women's Health; Young Adult
PubMed: 31340338
DOI: 10.1590/1518-8345.2806.3058 -
Revista Brasileira de Enfermagem 2020to investigate puerperal women who received guidance on childbirth during prenatal care and the behaviors experienced in the labor process within the context of good...
OBJECTIVES
to investigate puerperal women who received guidance on childbirth during prenatal care and the behaviors experienced in the labor process within the context of good obstetric practices from the perspective of puerperal women.
METHODS
a descriptive cross-sectional quantitative study conducted with 203 puerperal women admitted to the shared rooms of a teaching hospital between May and July 2017 during the immediate postpartum period. For data collection, was used an instrument adapted from the hospital questionnaire for puerperal women that was developed by the Oswaldo Cruz Foundation.
RESULTS
only 48.3% of puerperal women received the eight orientations regarding good obstetric practices during prenatal care, which were not experienced in the labor process, especially regarding referral and behaviors of the hospital team. Unfavorable socioeconomic conditions were significant in relation to guidelines provided during prenatal care.
CONCLUSIONS
prenatal care was negatively evaluated and there was lack of compliance with good obstetric practices and non-recommended behaviors in the labor process in the maternity ward.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Parturition; Patient Satisfaction; Pregnancy; Prenatal Care; Quality of Health Care
PubMed: 32609177
DOI: 10.1590/0034-7167-2019-0222 -
Telemedicine Journal and E-health : the... Oct 2023n p p p p p p (Comparative Study)
Comparative Study
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Topics: Female; Humans; Pregnancy; Cross-Sectional Studies; Delivery of Health Care; Hispanic or Latino; Prenatal Care; Telemedicine; White People; United States
PubMed: 36787485
DOI: 10.1089/tmj.2022.0492 -
JAMA Network Open Apr 2021Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in... (Comparative Study)
Comparative Study
IMPORTANCE
Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology.
OBJECTIVE
To explore the association of audio-only virtual prenatal care with perinatal outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included.
EXPOSURES
Prenatal care incorporating audio-only prenatal care visits.
MAIN OUTCOMES AND MEASURES
The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined.
RESULTS
The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended.
CONCLUSIONS AND RELEVANCE
Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.
Topics: Adult; Ambulatory Care; COVID-19; Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; SARS-CoV-2; Telemedicine; Texas
PubMed: 33852002
DOI: 10.1001/jamanetworkopen.2021.5854 -
NeoReviews May 2023Prenatal diagnosis of congenital heart disease makes it possible to optimize and coordinate care of the fetus and pregnant person. Benefits encompass the full spectrum...
Prenatal diagnosis of congenital heart disease makes it possible to optimize and coordinate care of the fetus and pregnant person. Benefits encompass the full spectrum of pre- and perinatal care, from counseling to optimization of pregnancy care and fetal intervention. Prenatal diagnosis reduces the likelihood of postnatal hemodynamic compromise and improves long-term neurodevelopmental outcomes. Despite the benefits, prenatal diagnosis rates remain suboptimal, particularly for lesions that are not seen on standard 4-chamber imaging views. Improving prenatal diagnosis rates requires education and outreach efforts targeting community practices where most initial screening occurs.
Topics: Pregnancy; Female; Humans; Prenatal Diagnosis; Fetal Diseases; Heart Defects, Congenital; Fetus; Prenatal Care
PubMed: 37122058
DOI: 10.1542/neo.24-5-e285 -
Journal of Women's Health (2002) Jun 2024The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. A consensus development study was conducted in the...
The aim of this study is to develop a core outcome set for the frequency and modality of prenatal care visits. A consensus development study was conducted in the United States with participants, including 31 health care professionals, 12 public policy members or public health payers, and 18 public members, representing 24 states. A modified Delphi method and modified nominal group technique were utilized. Twenty-one potential core outcomes were developed by combining the outcomes reported in three systematic reviews that evaluated the frequency of prenatal care visits or modality of prenatal visit type (, in person, telemedicine, or hybrids of both). Eighteen consensus outcomes were identified from the Delphi process, following which 10 maternal and 4 neonatal outcomes were agreed at the consensus development meeting. Maternal core outcomes include maternal quality of life; maternal mental health outcomes; the experience of maternity care; lost time; attendance of recommended visits; unplanned care utilization; completion of the American College of Obstetricians and Gynecologists-recommended services; diagnosis of obstetric complications-proportion and timing; disparities in care outcomes; and severe maternal morbidity or mortality. Neonatal core outcomes include gestational age at birth, birth weight, stillbirth or perinatal death, and neonatal intensive care unit admissions. The core outcome set for the frequency and modality of prenatal visits should be utilized in forthcoming randomized controlled trials and systematic reviews. Such application will warrant that in future research, consistent reporting will enrich care and improve outcomes. Clinical Trial Registration number: 2021.
Topics: Adult; Female; Humans; Pregnancy; Appointments and Schedules; Consensus; Delphi Technique; Outcome Assessment, Health Care; Pregnancy Outcome; Prenatal Care; Quality of Life; United States
PubMed: 38306165
DOI: 10.1089/jwh.2023.0592 -
Maternal and Child Health Journal Jul 2024To evaluate whether prenatal visits or screening/testing were fewer or occurred later during the initial phase of the COVID-19 pandemic in 2020 (CINT) as compared to the...
OBJECTIVE
To evaluate whether prenatal visits or screening/testing were fewer or occurred later during the initial phase of the COVID-19 pandemic in 2020 (CINT) as compared to the prior year (PreCINT).
METHODS
A retrospective cohort study compared CINT (n = 2,195) to PreCINT (n = 2,395) at seven public hospitals in New York City. The primary outcome was total number of prenatal-care visits. Secondary outcomes were components of prenatal-care visits completion, timing of standard pregnancy screening tests, and adverse neonatal outcomes.
RESULTS
CINT patients had more total prenatal-care visits (B = 1.30, 95% CI:1.04, 1.56, p < 0.001), lower odds for initiation of prenatal care which was inadequate according to widely used criteria (OR:0.39, 95% CI:0.34, 0.45, p < 0.001), and lower gestational age at initial visit (B=-4.51, 95% CI:-5.10, -3.93, p < 0.001) than PreCINT patients. In-person visits did not differ between the two groups. PreCINT patients had no televisits, while CINT patients had a median of one televisit (Median = 1, p < 0.001). CINT patients had increased odds for group B Streptococcus screening (OR:1.27, 95% CI: 1.10, 1.48, p = 0.001), quadrivalent screening (OR:1.30, 95% CI:1.15, 1.48, p < 0.001), and anatomy sonogram (OR:2.30, 95% CI:2.04, 2.59, p < 0.001) but decreased odds for glucose challenge test screening (OR:0.81, 95% CI:0.72, 0.91, p < 0.001). Adverse neonatal outcome did not differ between CINT and PreCINT pregnancies.
CONCLUSIONS FOR PRACTICE
Despite the difficulties and perceived dangers of in-person visits during the COVID-19 pandemic, the COVID-19 pandemic had little negative impact upon the outpatient prenatal care received by patients in this hospital system.
Topics: Humans; Female; COVID-19; Pregnancy; Prenatal Care; Retrospective Studies; Adult; New York City; SARS-CoV-2; Pandemics; Telemedicine
PubMed: 38270717
DOI: 10.1007/s10995-024-03904-8 -
International Journal of Medical... Feb 2023Exploitation of telehealth in prenatal care has the potential to reduce the access barrier to care and empower women to participate in their own care. This review aims... (Review)
Review
INTRODUCTION
Exploitation of telehealth in prenatal care has the potential to reduce the access barrier to care and empower women to participate in their own care. This review aims to assess the practical implications of virtual prenatal care and identify the needs and experiences associated with it.
METHODS
A systematic literature review was conducted in four electronic databases: PubMed, Web of Science, Scopus, and Cochrane. The keywords used were "pregnancy", "virtual visit", "prenatal", and others. The search included all relevant studies published from 2011 to 2021 written in English. Articles mentioning virtual prenatal care incorporating synchronous communication between pregnant women and health care professionals were included. Those unrelated to prenatal care or employing asynchronous means of virtual care were excluded. The review was structured following the PRISMA guidelines. Different quality appraisal methods such as JBI, CASP, NOS, and Cochrane were used to assess the methodological quality of the literature. The data were then analyzed based on the categorization of the studies.
RESULTS
Overall, 2863 articles were identified, of which 19 met the inclusion criteria after removing duplicates, screening of abstracts, and full text-four articles identified from hand-searching were incorporated, making a total of 23 eligible articles for the review. The studies' findings revealed the preference for implementing cost-effective virtual care based on the resource set, technological literacy, and consistent accessibility. Further, no significant differences in clinical outcomes were observed between two modes of care, virtual and in-person. The higher satisfaction by pregnant women and healthcare professionals indicated the continuity of the care. In addition, the hybrid model of virtual prenatal care integrated with traditional in-person care was acceptable to both low-risk and high-risk pregnant women. Virtual prenatal care substantially reduced travel time and absences from work, drops in clinic wait time and no-show rate, limited the risk of exposure during a pandemic, and increased self-accountability.
CONCLUSION
Virtual prenatal care offers predominant advantages over in-person when it is carefully designed with the inclusion of pregnant women and healthcare professionals' needs. Evidence showed that providing adequate technology training, proper instruction, and guidelines for initial setup and assurance of a reliable and accessible system is vital in increasing access to care.
Topics: Pregnancy; Humans; Female; Pregnant Women; Prenatal Care; Quality of Health Care; Health Personnel; Delivery of Health Care
PubMed: 36565547
DOI: 10.1016/j.ijmedinf.2022.104964 -
The Journal of Pediatrics Feb 2020
Review
Topics: Female; Gestational Age; Glucocorticoids; Humans; Maternal Health; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Prenatal Care
PubMed: 31606149
DOI: 10.1016/j.jpeds.2019.09.015