Should obstetricians see women with normal pregnancies ? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.
To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care.
Design-Multicentre randomised controlled trial
Setting-51 general practices linked to nine Scottish maternity hospitals.
Subject-1765 women at low risk of antenatal complications.
Intervention-Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications.
Main outcome measures-Comparisons of health service use, indicators of quality of care, and women's satisfaction.
Continuity of carer was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001).
Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001).
Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01).
Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not hav...
Mots-clés Pascal : Gestation, Surveillance sanitaire, Homme, Exploration clinique, Prénatal, Santé publique, Médecin généraliste, Sage femme, Obstétricien
Mots-clés Pascal anglais : Pregnancy, Sanitary surveillance, Human, Clinical investigation, Prenatal, General practitioner, Midwife
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0148960
Code Inist : 002B20F01. Création : 199608.