NICE recommendationsA schedule of antenatal appointments should be determined by the function of the appointments. For a woman who is nulliparous with an uncomplicated pregnancy, a schedule of ten appointments should be adequate. For a woman who is parous with an uncomplicated pregnancy, a schedule of seven appointments should be adequate. [B]
Early in pregnancy, all women should receive appropriate written information about the likely number, timing and content of antenatal appointments associated with different options of care and be given an opportunity to discuss this schedule with their midwife or doctor. [D]
Each antenatal appointment should be structured and have focused content. Longer appointments are needed early in pregnancy to allow comprehensive assessment and discussion. Wherever possible, appointments should incorporate routine tests and investigations to minimise inconvenience to women. [D]
Research questions1. What is the most effective frequency of antenatal visits? (Informed Recommendation 1)
- In low risk pregnant women is a schedule of 7–10 visits as effective as the traditional schedule of 14 visits in achieving positive perinatal outcomes?
- In low risk pregnant women is a schedule of 7–10 visits as effective as the traditional schedule of 14 visits in terms of women’s satisfaction with care?
- What is the optimal number/timing of visits for low risk primigravida and low risk multigravida?
3. In low risk women is a reduced schedule of visits (7–10) more cost effective than the traditional schedule of 14 visits? (No studies identified)
4. What information should be provided to women about the schedule of visits? (No studies identified)
- What is the impact of a woman’s expectations about the schedule of visits on her satisfaction with care? (No studies identified)
6. What are the additional considerations for Aboriginal and Torres Strait Islander Australian women? (Informed narrative)
Search StrategyDatabases searched: Medline; Embase; Psychinfo; Cochrane Database of Systematic Reviews; Australasian Medical Index.
Date of searches: February 2009; November 2010
Limits: English language
Publication dates for searches:
1. January 2003 – February 2009
2. January 2008 – November 2010
Review findings1. 1 level I and 3 level IV studies identified. The Cochrane review suggests that where the number of visits is already low, these should not be further reduced.
2. 1 level IV study found that initiating antenatal care in the first trimester had no significant effect on birth weight
3. No studies identified
4. No studies identified
5. No studies identified
6. 1 level IV study and 2 qualitative reviews informed narrative around antenatal visits for Aboriginal and Torres Strait Islander women
New evidence is limited and does not suggest a change to the NICE recommendations. However, the evidence base is strengthened by the recent Cochrane review.
EAC recommendation1. Determine the schedule of antenatal visits based on the individual woman’s needs. For a woman’s first pregnancy without complications, a schedule of ten visits should be adequate. For subsequent uncomplicated pregnancies, a schedule of seven visits should be adequate.
Evidence supporting recommendation (see Section 6.5)Carroli et al 2001; Clemet et al 1996; Dowswell et al 2010; Hildingsson et al 2002; Villar & Khan-Neelofur 2003
Grading of evidence — Recommendation 1Evidence base - A
Consistency - B
Clinical impact - A
Generalisablity - A
Applicability - B
Recommendation - B
Consensus-based recommendationsi. At the first contact with a woman during pregnancy, make arrangements for the first antenatal visit, which requires a long appointment and should occur within the first 10 weeks.
ii. Early in pregnancy, provide women with information in an appropriate format about the likely number, timing and content of antenatal visits associated with different options of care and the opportunity to discuss this schedule.