Effects of a reduced-visit prenatal care clinical practice guideline.

PURPOSE

A prenatal care guideline that decreased scheduled visits to 9 was introduced at a military community hospital in 2000. We hypothesized patients would have fewer clinic visits with no difference in maternal and neonatal outcomes under the new schedule.

METHODS

We designed a retrospective cohort study involving patients who delivered after 20 weeks gestation during 1999 (1647) and 2000 (1710). We measured the number of antenatal visits to clinic and labor and delivery (L&D) per patient. We assessed maternal and neonatal outcomes. Power was adequate to detect a 25-g change in birth weight. Descriptive, chi(2), and t test statistics were used.

RESULTS

The number of prenatal visits decreased from 10.9 +/- 2.8 to 9.2 +/- 2.6 (P < .001) per patient. Outpatient visits to L&D increased by 31 per month, P = .01. Post-term deliveries decreased from 10.4 to 8.1%, P = .01. Maternal and neonatal outcomes did not decline. Patient satisfaction did not change.

DISCUSSION

Application of the prenatal care guideline was associated with a reduction in prenatal visits but a small increase in L&D visits that did not persist after the initial year. No adverse perinatal or patient satisfaction outcomes were noted.

CONCLUSIONS

This guideline is efficient in delivering prenatal care with no changes in perinatal outcomes or patient satisfaction.