Antenatal day care units versus hospital admission for women with pregnancy complications

Many women experience complications during pregnancy such as high blood pressure, threatened early labour or abnormal and heavy bleeding (haemorrhage). Admission to hospital may be necessary but can be disruptive to the mother and her family. Often tests and monitoring are needed so that the condition of the mother and baby can be assessed and treatment can be provided. Sometimes this care can be given in day care units to avoid the need for an overnight stay in hospital. The review compares day care units with hospital admission or routine care. Three trials, involving 504 pregnant women with high blood pressure or preterm prelabour rupture of the membranes, were included in the review. The findings were that women receiving day care had to make more visits to hospital as outpatients but were less likely to stay in hospital overnight. Care in day units did not seem to affect other outcomes for mothers and babies or increase or reduce interventions in labour; although women in one trial were less likely to have their labours induced if they received day care. Two studies provided evidence that women preferred day care to hospital admission and no women expressed a preference for more inpatient care; most women in both groups felt they had received good care and were satisfied with it.

The aim of antenatal care is to reduce adverse outcomes for mothers and babies but these are relatively infrequent and could not be investigated in this review. A proportion of women attending for day care require subsequent inpatient care, and a range of non-medical considerations such as travelling distance to emergency facilities, social factors and women's emotional wellbeing may lead to admission to hospital. All studies included in the review were carried out as part of evaluations of new services.

Authors' 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.

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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.

Objectives: 

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.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009).

Selection criteria: 

Randomised controlled trials comparing day care with inpatient or routine care for women with complicated pregnancy.

Data collection and analysis: 

Two review authors independently carried out data extraction and assessed studies for risk of bias.

Main 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.

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