[Compliance and efficacy of standard antenatal care model].

Objective: To investigate the compliance of standard antenatal care (ANC) model with 12-13 visits currently used in Beijing region, and to assess the efficacy of this model in reducing adverse maternal and perinatal complication.

Methods: The clinical data of 544 women who delivered at Peking Union Medical College Hospital (West Section) from January 1, 1999 to December 31, 2002 were retrospectively reviewed and analyzed. Three areas were addressed in this paper: compliance of pregnant women with standard ANC model; association of maternal and perinatal complication with different number of ANC visits; effectiveness of screening for risk factors at the first ANC visit.

Results: A median of 8 ANC visits was made in 544 cases, of whom 22 cases (4.0%) never had ANC visit before delivery. The women were divided into three groups according to the status of residence and education levels: temporary residents in Beijing city (group A), permanent residents with middle or low education level (group B), and permanent residents with high education level (group C). The average number of ANC visits in group A was 4.55 +/- 3.1, which was much lower than in group B (8.71 +/- 2.2) and in group C (9.56 +/- 2.1) (P < 0.001). The mean duration of gestation at the first ANC visit in group A was (25.44 +/- 8.8) weeks much longer than (15.58 +/- 5.8) weeks in group B and (14.24 +/- 3.2) weeks in group C (P < 0.001). Among 544 cases, 93 (17.1%) had ANC visit for 0-3 times, 299 (55.0%) for 4-9 times and 152 (27.9%) for > or = 10 times. There was no statistical difference among varied number of ANC visits when the results were pooled for pregnancy induced hypertension, gestational diabetes mellitus, vaginal bleeding at the second and third trimesters, postpartum hemorrhage, fetal macrosomia, premature rupture of membrane, and fetal distress (P > 0.05). An increase in the number of ANC visits was associated with the decreased rates of fetal growth restriction (P < 0.05) and premature delivery (P < 0.05), whereas it was paralleled with increased rates of anemia and cesarean section (P < 0.001). It was found that 35.6% of women who developed maternal and perinatal complications would be identified through screening for risk factors at the first ANC visit.

Conclusions: Standard ANC model is currently not well complied. It has limited efficacy in reducing most maternal and perinatal complications. A more practical and effective ANC model for low educated women and temporary residents needs to be explored.