Abstract:
Objective-To analyse the effect of a fetal surveillance
unit, which undertakes a wide range of
maternal and fetal tests on an outpatient or inpatient
basis, on the number and length of antenatal hospital
admissions.
Design-A comparison of the number and length
of antenatal admissions six months before and five
months after the opening of the unit on 1 July 1990.
Main outcome measures-Admission rate, antenatal
bed occupancy, and interval from admission to
discharge or delivery.
Results-The antenatal bed occupancy rate fell by
22% from 174/100 deliveries during the six months
before the unit was opened to 136/100 deliveries in
the five months after it was opened. The difference
in distribution of lengths of admission after the unit
was opened from before was highly significant
(Mann-Whitney test=5-14, n=752 and 679;
p<0-0001), and this was due to shorter intervals
from admission to discharge and from admission to
delivery. In contrast, the antenatal admission rate
did not change significantly (50/100 deliveries
v 49/100 deliveries). There was no significant change
in the stillbirth rate (6/1294 births v 8/1372 births;
difference between rates=0 0012, 95% confidence
interval -0 0043 to 0 0067).
Conclusion-Obstetricians are more prepared to
discharge antenatal patients from hospital and,
similarly, admit patients for delivery rather than for
assessment if the patients are reliably monitored on
an outpatient basis. If this change in practice is
sustained substantial financial and social benefits
will result as well as improvements in organisation,
audit, teaching, and research.
