Day care is increasingly being used for complications of pregnancy, despite little evidence that it is effective. Deborah Turnbull from the University of Adelaide, Australia and colleagues assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward.
395 women with pregnancy complications (high blood pressure or ruptured fetal membranes) were randomly assigned day (263) or ward (132) care. There was no difference in health outcomes between the two groups and no cost saving for day-care services. However, women who had day care expressed more satisfaction than those admitted to hospital, and experienced shorter hospital stays (17 hours compared with 2 days and 9 hours).
Professor Turnbull comments: "We suggest that the results of this trial might be generalisable to other common and slowly progressing medical complications of pregnancy such as diabetes and hyperemesis. Against a backdrop of similar clinical outcomes and costs, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate".
In an accompanying Commentary (p 1089), Phillip Stubblefield from Boston University School of Medicine, USA, concludes: "Some words of caution are necessary before widespread adoption of antenatal day care for pregnancy complications. There were no cost savings, as measured here. Day care requires duplication of space and staff resources… these women all had serious conditions that can, rarely, become life-threatening with little warning. Women with mild pre-eclampsia (proteinuric hypertension) can progress to severe illness over a few hours. Similarly, patients with preterm premature rupture of the fetal membranes can fail to manifest signs of sepsis until it is overwhelming. A larger sample might have included patients with a rapidly developing illness, for whom hospital care would have made a difference".
Contact: Professor Deborah Turnbull, Department of General Practice, University of Adelaide, North Tce, Adelaide 5005, Australia;
T) 61-8-8303-3460;
F) 61-8-8303-3511;
E) deborah.turnbull@adelaide.edu.au
Dr Phillip G Stubblefield, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Centre, MA 02118, USA;
T) 617-638-8040;
E) Phillip.stubblefield@bmc.org
Journal
The Lancet