Biomaterial Database

Antenatal day care units versus hospital admission for women with complicated pregnancy. 2009

Therese Dowswell, and Philippa Middleton, and Andrew Weeks

Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, First Floor, Liverpool Women's NHS Foundation Trust, Liverpool, UK, L8 7SS.

BACKGROUND Antenatal day care units have been widely used as an alternative to inpatient care for women with pregnancy complications including mild and moderate hypertension, and preterm prelabour rupture of the membranes. OBJECTIVE The objective of this review is to compare day care units with routine care or hospital admission for women with pregnancy complications in terms of maternal and perinatal outcomes, length of hospital stay, acceptability, and costs to women and health services providers. METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009). METHODS Randomised controlled trials comparing day care with inpatient or routine care for women with complicated pregnancy. METHODS Two review authors independently carried out data extraction and assessed studies for risk of bias. RESULTS Three trials with a total of 504 women were included. For most outcomes it was not possible to pool results from trials in meta-analyses as outcomes were measured in different ways.Compared with women in the ward/routine care group, women attending day care units were less likely to be admitted to hospital overnight (risk ratio 0.46, 95% confidence interval 0.34 to 0.62). The average length of antenatal admission was shorter for women attending for day care, although outpatient attendances were increased for this group. There was evidence from one study that women attending for day care were significantly less likely to undergo induction of labour, but mode of birth was similar for women in both groups. For other outcomes there were no significant differences between groups.The evidence regarding the costs of different types of care was mixed; while the length of antenatal hospital stays were reduced, this did not necessarily translate into reduced health service costs.While most women tended to be satisfied with whatever care they received, women preferred day care compared with hospital admission. CONCLUSIONS Small studies suggest that there are no major differences in clinical outcomes for mothers or babies between antenatal day units or hospital admission, but women may prefer day care.

UI	MeSH Term	Description	Entries
D006973	Hypertension	Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.	Blood Pressure, High,Blood Pressures, High,High Blood Pressure,High Blood Pressures
D007902	Length of Stay	The period of confinement of a patient to a hospital or other health facility.	Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
D011247	Pregnancy	The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.	Gestation,Pregnancies
D011249	Pregnancy Complications, Cardiovascular	The co-occurrence of pregnancy and a cardiovascular disease. The disease may precede or follow FERTILIZATION and it may or may not have a deleterious effect on the pregnant woman or FETUS.	Cardiovascular Pregnancy Complications,Complications, Cardiovascular Pregnancy,Pregnancy, Cardiovascular Complications,Cardiovascular Pregnancy Complication,Complication, Cardiovascular Pregnancy,Pregnancies, Cardiovascular Complications,Pregnancy Complication, Cardiovascular
D003362	Cost-Benefit Analysis	A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. In contrast a cost effectiveness in general compares cost with qualitative outcomes.	Cost and Benefit,Cost-Benefit Data,Benefits and Costs,Cost Benefit,Cost Benefit Analysis,Cost-Utility Analysis,Costs and Benefits,Economic Evaluation,Marginal Analysis,Analyses, Cost Benefit,Analysis, Cost Benefit,Analysis, Cost-Benefit,Analysis, Cost-Utility,Analysis, Marginal,Benefit and Cost,Cost Benefit Analyses,Cost Benefit Data,Cost Utility Analysis,Cost-Benefit Analyses,Cost-Utility Analyses,Data, Cost-Benefit,Economic Evaluations,Evaluation, Economic,Marginal Analyses
D003631	Day Care, Medical	Institutional health care of patients during the day. The patients return home at night.	Day Care,Hospitalization, Partial,Care, Day,Medical Day Care,Partial Hospitalization
D005260	Female		Females
D005322	Fetal Membranes, Premature Rupture	Spontaneous tearing of the membranes surrounding the FETUS any time before the onset of OBSTETRIC LABOR. Preterm PROM is membrane rupture before 37 weeks of GESTATION.	Premature Rupture of Membrane (Pregnancy),PROM (Pregnancy),Premature Rupture of Fetal Membranes,Preterm PROM (Pregnancy),Preterm Premature Rupture of Fetal Membranes,Membrane Premature Rupture (Pregnancy),Membrane Premature Ruptures (Pregnancy),PROM, Preterm (Pregnancy)
D006757	Hospital Units	Those areas of the hospital organization not considered departments which provide specialized patient care. They include various hospital special care wards.	Hospital Unit,Unit, Hospital,Units, Hospital
D006760	Hospitalization	The confinement of a patient in a hospital.	Hospitalizations