Clinical, Psychosocial, and Economic Effects of Antenatal Day Care for 3 Medical Complications of Pregnancy: A Randomized, Controlled Trial of 395 Women.

摘要

Although day care is increasingly used to manage complications of pregnancy, its efficacy is far from proved. This study examined the clinical, psychosocial, and economic effects of day care for 3 pregnancy complications: nonproteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes. The study population included 263 women assigned to day care and 132 others cared for on a medical ward. Day care encouraged family members to accompany affected women throughout the day. The day-care unit was staffed by full-time-equivalent midwives. Tests began on admission to day care, with initial results available within 2 to 3 hours. Most women were discharged home within a few hours. Data were obtained through case-note reviews, self-report questionnaires, and financial information provided by the hospital. The total antenatal stay was significantly shorter in the day-care group than for ward patients. Shorter stays were accompanied by a median of 1 extra antenatal hospital visit and a median of 1 less admission to the antenatal ward. The median total of care episodes, including day-care visits, antenatal ward admissions, emergency department visits, and admission to a high-dependency unit, was 3 in the day-care group and 2 in the ward group. The numbers of women having augmentation or induction of labor were similar for the 2 groups. There were no clinically important group differences in maternal or perinatal outcomes. A shorter antenatal day in the day-care group correlated with a significantly shorter stay for the mother and infant. Costs reflecting intensity of care did not differ substantially. Possibly, these results could be extrapolated to other common and slowly progressing medical complications of pregnancy such as diabetes and hyperemesis. It seems appropriate to provide women a choice between hospital admission and day care.