Content of prenatal care during the initial workup

OBJECTIVE: In its landmark document Caring for Our Future: The Content of Prenatal Care, the Public Health Service Expert Panel on the Content of Prenatal Care presented a framework for refocusing prenatal care in the 1990s. The purpose of this study was to examine the extent to which the panel's recommendations for preconceptional care and for the content of the initial prenatal workup were followed 3 years after they were issued. STUDY DESIGN: A retrospective review of the prenatal records of 147 patients in Durham and Chatham counties, North Carolina, was conducted. Providers were selected at random, and their first 10 new prenatal patients were enrolled in the study. Data were analyzed descriptively to characterize patterns in content of care and, with multiple logistic regression analysis, to determine whether there were relationships between selected maternal characteristics and receipt of selected components of care. RESULTS: Only 11% of the patients had one or more preconceptional visits. During the initial prenatal workup risk assessment through history taking and physical examination was virtually complete, whereas documentation of laboratory tests varied. Only about half the population received routine counseling on pregnancy and health behaviors. Multiple logistic regression analysis revealed a consistent association between initiating prenatal care early in pregnancy and receipt of most laboratory tests. No other consistent relationships were found. CONCLUSIONS: This study suggests that adherence to such long-standing prenatal care practices as physical examination, history taking, and some laboratory tests was high. But the components of prenatal care recommended by the expert panel to ensure behavioral risk assessments and health promotion and education early in pregnancy were provided at lower and more variable rates. Use of preconceptional care was also low. Further research into the use and content of care before and during pregnancy is required to understand variations in practice patterns and levels of adherence to recommendations on the content of care. (A M J O BSTET G YNECOL 1996;174:220-6.)