The University of Southampton
University of Southampton Institutional Repository

Clinical, psychological and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women

Clinical, psychological and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women
Clinical, psychological and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women
Background: Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward.
Methods: 395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81·0% or higher) and via the hospital's financial system. Analysis was by intention to treat.
Findings: All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5–9] vs 57 [35–123] h; p=0·001). Overall stay was also significantly shorter in the day-care group (mean 7·22 [SE 0·31] vs 8·53 [0·44]; p=0·014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0·01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care.
Interpretation: Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.
effects of antenatal day care, medical complications of pregnancy, clinical psychosocial economic effects
0140-6736
1104-1109
Turnbull, D.
3ee59e0c-6351-4e0a-a272-901a10300e23
Wilkinson, C.
ed3575e1-f146-4588-8795-50d1909f895c
Gerard, K.
ce7b5859-1c5f-4e9f-b5ba-acbd68d0f90e
Shanahan, M.
4f70211a-515f-4727-bc9c-18b8cab1129c
Ryan, P.
0ec594f1-7e73-438f-9b1e-5a8e35373ebc
Griffith, E.
e0d30001-dad4-4258-a48a-3e4e71c773cc
Kruzins, G.
10c6ca68-c8fc-4b63-9f2a-d9c6c2fc9d4e
Stamp, G.
23d26ece-396f-48da-8bb0-4def40d0c4fa
Turnbull, D.
3ee59e0c-6351-4e0a-a272-901a10300e23
Wilkinson, C.
ed3575e1-f146-4588-8795-50d1909f895c
Gerard, K.
ce7b5859-1c5f-4e9f-b5ba-acbd68d0f90e
Shanahan, M.
4f70211a-515f-4727-bc9c-18b8cab1129c
Ryan, P.
0ec594f1-7e73-438f-9b1e-5a8e35373ebc
Griffith, E.
e0d30001-dad4-4258-a48a-3e4e71c773cc
Kruzins, G.
10c6ca68-c8fc-4b63-9f2a-d9c6c2fc9d4e
Stamp, G.
23d26ece-396f-48da-8bb0-4def40d0c4fa

Turnbull, D., Wilkinson, C., Gerard, K., Shanahan, M., Ryan, P., Griffith, E., Kruzins, G. and Stamp, G. (2004) Clinical, psychological and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women. The Lancet, 363 (9415), 1104-1109. (doi:10.1016/S0140-6736(04)15893-5).

Record type: Article

Abstract

Background: Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward.
Methods: 395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81·0% or higher) and via the hospital's financial system. Analysis was by intention to treat.
Findings: All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5–9] vs 57 [35–123] h; p=0·001). Overall stay was also significantly shorter in the day-care group (mean 7·22 [SE 0·31] vs 8·53 [0·44]; p=0·014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0·01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care.
Interpretation: Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.

This record has no associated files available for download.

More information

Published date: 3 April 2004
Keywords: effects of antenatal day care, medical complications of pregnancy, clinical psychosocial economic effects
Organisations: Nursing & Midwifery

Identifiers

Local EPrints ID: 19217
URI: http://eprints.soton.ac.uk/id/eprint/19217
ISSN: 0140-6736
PURE UUID: bb14ef92-6140-44ee-8041-f5ed718f3b3c

Catalogue record

Date deposited: 31 Jan 2006
Last modified: 15 Aug 2024 17:10

Export record

Altmetrics

Contributors

Author: D. Turnbull
Author: C. Wilkinson
Author: K. Gerard
Author: M. Shanahan
Author: P. Ryan
Author: E. Griffith
Author: G. Kruzins
Author: G. Stamp

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×