Australian and New Zealand Journal of Obstetrics and Gynaecology · 1992 · 12 citations · 0 references
Public HealthMaternal HealthObstetricsMaternal MortalityMaternal-fetal MedicineObstetric ComplicationsAntenatal AssessmentAntenatal CareMaternal CareObstetric ManagementPregnancyPrenatal CareAntenatal Care PlanningFrequency Of Antenatal VisitsInitial Patient AssessmentPerinatal Mortality EpidemiologyPerinatal Mortality StatisticsPregnancy-related ComplicationsPublic Hospital ManagementQuality Of Antenatal Care
EDITORIAL COMMENT: For the purposes of comparison of perinatal mortality rates with other papers discussing shared care/birth centre care, it should be noted that 2 of the 5 perinatal deaths in the 780 women who completed shared care (tables 4 and 5), and 2 of the deaths in the 185 women who were removed from the shared care programme (tables 6 and 7) were associated with birth‐weight less than 500 g, the criterion for inclusion of perinatal deaths for statistical purposes in the State of Victoria. With these cases excluded the perinatal mortality rate for the entire series of 962 women was 7.2 per 1,000 births; the rate was 3.9 per 1,000 in the 778 women who remained in the shared care programme, and 20.6 per 1,000 births in the 184 women who were removed from the programme. Summary: The organization and function of a public hospital based shared antenatal care programme is described. The programme has proved to be popular with pregnant women and local practitioners and currently 24% of public antenatal patients attending the hospital are cared for in this way. The study presents the results of management of 1,000 consecutive low risk patients whose antenatal care was shared between hospital doctors at the Royal Women's Hospital, Melbourne and local practitioners. Two hundred and twenty patients did not complete the programme because of social factors, medical diseases or pregnancy complications. The 780 patients who did complete the programme had a lower Caesarean section rate than the overall hospital population (8.3% compared with 18.5%) and a lower perinatal mortality rate (6.4 compared with 20.5 per 1,000 births). It is essential that patients are carefully assessed at their hospital booking visit before embarking on such a programme. Equally, careful assessment by local practitioners is important as abnormalities such as essential hypertension may be overlooked at the initial hospital assessment or may arise between the hospital visits.