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. 2009 Oct 7;2009(4):CD001803.
doi: 10.1002/14651858.CD001803.pub2.

Antenatal day care units versus hospital admission for women with complicated pregnancy

Therese Dowswell  1 , Philippa Middleton, Andrew Weeks
Affiliations

Antenatal day care units versus hospital admission for women with complicated pregnancy

Therese Dowswell et al. Cochrane Database Syst Rev. .

Abstract

Background: Antenatal day care units have been widely used as an alternative to inpatient care for women with pregnancy complications including mild and moderate hypertension, and preterm prelabour rupture of the membranes.

Objectives: The objective of this review is to compare day care units with routine care or hospital admission for women with pregnancy complications in terms of maternal and perinatal outcomes, length of hospital stay, acceptability, and costs to women and health services providers.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009).

Selection criteria: Randomised controlled trials comparing day care with inpatient or routine care for women with complicated pregnancy.

Data collection and analysis: Two review authors independently carried out data extraction and assessed studies for risk of bias.

Main results: Three trials with a total of 504 women were included. For most outcomes it was not possible to pool results from trials in meta-analyses as outcomes were measured in different ways.Compared with women in the ward/routine care group, women attending day care units were less likely to be admitted to hospital overnight (risk ratio 0.46, 95% confidence interval 0.34 to 0.62). The average length of antenatal admission was shorter for women attending for day care, although outpatient attendances were increased for this group. There was evidence from one study that women attending for day care were significantly less likely to undergo induction of labour, but mode of birth was similar for women in both groups. For other outcomes there were no significant differences between groups.The evidence regarding the costs of different types of care was mixed; while the length of antenatal hospital stays were reduced, this did not necessarily translate into reduced health service costs.While most women tended to be satisfied with whatever care they received, women preferred day care compared with hospital admission.

Authors' conclusions: Small studies suggest that there are no major differences in clinical outcomes for mothers or babies between antenatal day units or hospital admission, but women may prefer day care.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 1 Length of antenatal stay.
1.2
1.2. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 2 Women admitted antenatally.
1.3
1.3. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 3 Outpatient hospital visits.
1.4
1.4. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 4 Total antenatal care episodes.
1.5
1.5. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 5 Antenatal hospital stay for less than three days (as either inpatient or staying on the day unit).
1.6
1.6. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 6 Maternal mortality.
1.7
1.7. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 7 Maternal complications.
1.8
1.8. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 8 Maternal high blood pressure.
1.9
1.9. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 9 Perinatal mortality.
1.10
1.10. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 10 Apgar score at five minutes.
1.11
1.11. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 11 Apgar score seven or less at five minutes.
1.12
1.12. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 12 Gestational age at delivery (days).
1.13
1.13. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 13 Admission to intensive care unit/special care unit.
1.14
1.14. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 14 Birthweight (grams).
1.15
1.15. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 15 Postnatal stay.
1.16
1.16. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 16 Women requiring readmission after discharge (postnatal).
1.17
1.17. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 17 Women visiting emergency department after discharge (postnatal).
1.18
1.18. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 18 Induction/augmentation of labour.
1.19
1.19. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 19 Normal vaginal birth.
1.20
1.20. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 20 Forceps birth.
1.21
1.21. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 21 Caesarean section.
1.22
1.22. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 22 Dissatisfaction with care: "spent too much time in hospital".
1.23
1.23. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 23 Dissatisfaction with care: "I am satisfied with the care I received" (number disagreeing or not sure).
1.24
1.24. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 24 Dissatisfaction with care: "my care was very good" (number not sure or disagreeing).
1.25
1.25. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 25 Dissatisfaction with care: "I felt I was being well looked after" (number not sure or disagreeing).
1.26
1.26. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 26 Average total length of stay (antenatal, intrapartum, postnatal) all cases (mothers and babies).
1.27
1.27. Analysis
Comparison 1 Antenatal day care units versus inpatient care, Outcome 27 Public health cost: average total cost (all cases, includes mothers and babies)(Australian $s).
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References

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