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Content of prenatal care during the initial workup
M D Peoples-Sheps1, V K Hogan, N Ng'andu
1Department of Maternal and Child Health School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
Insights
Adherence to recommended preconceptional care and health promotion counseling in prenatal care was low, despite high rates of initial physical exams and history taking. Further research is needed to understand variations in practice and adherence to prenatal care guidelines.
Area of Science:
- Public Health
- Maternal and Child Health
- Healthcare Quality Improvement
Background:
- The Public Health Service Expert Panel on the Content of Prenatal Care established guidelines for prenatal care in the 1990s.
- These guidelines aimed to refocus prenatal care, emphasizing preconceptional care and the initial prenatal workup.
- Assessing adherence to these recommendations is crucial for evaluating the effectiveness of prenatal care delivery.
Purpose of the Study:
- To evaluate the extent to which recommendations for preconceptional care and the initial prenatal workup were implemented.
- To assess adherence to the 1990s framework for prenatal care content.
- To identify factors associated with the receipt of specific components of prenatal care.
Main Methods:
- A retrospective review of prenatal records for 147 patients in North Carolina.
- Random selection of healthcare providers and enrollment of their first 10 new prenatal patients.
- Descriptive analysis of care patterns and logistic regression to identify associations between maternal characteristics and care components.
Main Results:
- Only 11% of patients received preconceptional visits.
- Risk assessment via history and physical examination was nearly complete; laboratory test documentation varied.
- Routine counseling on pregnancy and health behaviors was provided to about half of the patients.
- Early initiation of prenatal care was associated with receiving most laboratory tests; no other consistent relationships were found.
Conclusions:
- Adherence to established prenatal care practices like physical exams and history taking was high.
- Implementation of recommended behavioral risk assessments, health promotion, and education was inconsistent and rates were lower.
- Preconceptional care utilization was notably low.
- Further research is necessary to understand practice variations and adherence to prenatal care content recommendations.
Objective:
In its landmark document Caring for Our Future: The Content of Prenatal Care, the Public Health Service Expert Panel on the Content of Prenatal Care presented a framework for refocusing prenatal care in the 1990s. The purpose of this study was to examine the extent to which the panel's recommendations for preconceptional care and for the content of the initial prenatal workup were followed 3 years after they were issued.
Study Design:
A retrospective review of the prenatal records of 147 patients in Durham and Chatham counties, North Carolina, was conducted. Providers were selected at random, and their first 10 new prenatal patients were enrolled in the study. Data were analyzed descriptively to characterize patterns in content of care and, with multiple logistic regression analysis, to determine whether there were relationships between selected maternal characteristics and receipt of selected components of care.
Results:
Only 11% of the patients had one or more preconceptional visits. During the initial prenatal workup risk assessment through history taking and physical examination was virtually complete, whereas documentation of laboratory tests varied. Only about half the population received routine counseling on pregnancy and health behaviors. Multiple logistic regression analysis revealed a consistent association between initiating prenatal care early in pregnancy and receipt of most laboratory tests. No other consistent relationships were found.
Conclusions:
This study suggests that adherence to such long-standing prenatal care practices as physical examination, history taking, and some laboratory tests was high. But the components of prenatal care recommended by the expert panel to ensure behavioral risk assessments and health promotion and education early in pregnancy were provided at lower and more variable rates. Use of preconceptional care was also low. Further research into the use and content of care before and during pregnancy is required to understand variations in practice patterns and levels of adherence to recommendations on the content of care.