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Clinical Trial
. 1996 Mar 2;312(7030):554-9.
doi: 10.1136/bmj.312.7030.554.

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

J S Tucker  1 , M H Hall, P W Howie, M E Reid, R S Barbour, C D Florey, G M McIlwaine
Affiliations
Clinical Trial

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

J S Tucker et al. BMJ. .

Abstract

Objective: 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.

Subjects: 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.

Results: Continuity of care 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 have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6).

Conclusion: Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.

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Comment in

  • Antenatal care on trial.
    Neilson J. Neilson J. BMJ. 1996 Mar 2;312(7030):524-5. doi: 10.1136/bmj.312.7030.524. BMJ. 1996. PMID: 8595270 Free PMC article. No abstract available.

References

    1. JAMA. 1988 Jan 8;259(2):225-8 - PubMed
    1. Lancet. 1980 Jul 12;2(8185):78-80 - PubMed
    1. Lancet. 1983 Sep 24;2(8352):695-8 - PubMed
    1. Lancet. 1984 Apr 21;1(8382):865-7 - PubMed
    1. Soc Sci Med. 1984;19(11):1197-200 - PubMed