Research
Obstetrics
Prenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care

https://doi.org/10.1016/j.ajog.2007.05.040Get rights and content

Objective

The objective of the study was to describe the patient characteristics of prenatal care utilization within and outside of routine obstetric care, and the clinical and psychosocial factors that predict care utilization.

Study Design

Four hundred twenty pregnant women enrolled in a randomized controlled trial receiving prenatal care in a university-affiliated clinic. All hospital encounters were obtained by review of computerized databases. The Kotelchuck index (KI) was computed, and the characteristics of inadequate, adequate, or excessive prenatal care were described. Demographic and psychosocial predictors of unscheduled visits were evaluated.

Results

A total of 50.5% of women were adequate users by KI, with 19% being inadequate. An average of 5 additional unscheduled encounters occurred (standard deviation 4.2; range, 0-26). Almost 75% of participants made an unscheduled obstetric visit, with 38% making 2 or more unscheduled visits. Overweight/obese, younger women, high symptom distress, and excessive and inadequate prenatal users were more likely to utilize the labor floor before delivery.

Conclusion

Unscheduled care is common during pregnancy.

Section snippets

Study participants

Data from this study came from 503 pregnant women enrolled in a randomized controlled trial aimed at promoting improved general health and reproductive behaviors through group prenatal care. This was a prospective study following up participants from early pregnancy through 1 year postpartum. Participants were recruited from 2 university-affiliated obstetrics clinics in New Haven, CT, and Atlanta, GA. Inclusion criteria were: (1) pregnancy at less than 24 weeks’ gestation; (2) age younger than

Results

The sample consisted of 503 participants; 67 were excluded from analyses because they had medical conditions during pregnancy that could require additional medical visits: hypertension, diabetes, preeclampsia, multiple gestation, and fetal abnormalities. In addition, 16 participants did not complete time 2 assessments. This resulted in a final sample of 420 patients for these analyses. The 420 patients did not differ from the 83 participants not included in these analyses on any of the primary

Comment

Our study demonstrates that nearly one-third of prenatal care patients receive “adequate plus” or “excessive” scheduled prenatal care visits. This confirms the observations of Kotelchuck, who applied his index to the 1980 National Natality Survey and demonstrated that 22.2% received intensive adequate plus care.7 Analysis of birth statistics from 1981-1995 revealed a major increase in prenatal care utilization, which was mostly accounted for by an increase in excessive utilization from 18.4% in

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    Cite this article as: Magriples U, Kershaw TS, Rising SS, et al. Prenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care. Am J Obstet Gynecol 2008;198:75.e1-75.e7.

    This work supported in part by National Institute of Mental Health Grant R01 MH/HD61175 to (to J.R.I.).

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