Randomised, controlled trial of clinical efficacy of antenatal day care

HYPOTHESIS: For certain clinical conditions, as an alternative to hospital admission, antenatal Day Care: is more cost effective; will result in no differences in clinical outcomes; will reduce specified interventions and investigations; and will lead to improved satisfaction and psychological well being. This presentation will concentrate on the clinical variables. METHODS: The trial was conducted at the Women’s and Children’s Hospital, a metropolitan level III teaching hospital with approximately 4000 deliveries per year. Women were randomised using the Zelen method in a 2:1 ratio between day care and ward for the following major diagnostic categories: non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes. Clinical data were obtained through retrospective case note review. Data were analysed by intention to treat. FINDINGS: The baseline characteristics of women in the two study groups were similar (e.g.: mean (SD) age at randomisation: Day Care – 28.9 years (5.3), Ward – 28.1 (5.7) years; primiparous: Day Care – 62.7%, Ward – 62.1%). OUTCOMES: The perinatal outcomes of the two groups were very similar (Table). INTERVENTIONS: Day Care resulted in a statistically significant reduction in the number of antenatal admissions (Median = 0.0, Ward = 1.0, P < 0.0001). There was a small, non-statistically significant difference in induction of labour (Day Care – 54.4%, Ward – 57.6%, Diff = −3.2%, 95% CI: −13.6% to 7.2%). Overall mode of delivery was similar (Spontaneous vaginal delivery: Day Care – 51.7%, Ward – 51.5%; Ventouse extraction: Day Care – 8.7%, Ward – 6.8%; Forceps delivery: Day Care – 8.7%, Ward − 12.9% Elective CS: Day Care – 3.4%, Ward − 5.3%; Emergency CS: Day Care – 27.4%, Ward – 23.5% ( χ2 = 3.17, df = 4, P = 0.5)).