How much did routine pregnancy testing differ between Dutch obstetricians and midwives?

Details

Pregnant women are encouraged to book for antenatal care, but little is known about what that care contains, particularly its various test procedures. This descriptive study assessed variation in standard antenatal testing procedures in The Netherlands.

Researchers conducted a nationwide structured survey by mailed questionnaire among specialist obstetricians and midwives in The Netherlands. Representatives of every obstetric practice registered with the Dutch Society of Obstetrics and Gynecology (n=132) and a sample of midwives registered with the Dutch Society of Midwives (n=394) were invited to report their own setting’s standard policies for routine antenatal tests. They were also asked for their views on the potential impact of the antenatal care program on pregnancy outcome.

Complete information was available from 105 specialist obstetricians (80%) and 281 midwives (71%). Maternal blood pressure and weight assessment were reportedly the most common routine antenatal procedures. Within each profession, however, reported definitions of abnormal findings and their implications varied markedly, especially for identifying and managing hypertensive disorders in pregnancy. Serial examinations of the cervix were not standard policy in either group.

Laboratory testing showed considerable variation both within and between professions, particularly for maternal serum glucose, rubella antibody titer, and urinary dipstick testing for glucose and protein. Standard ultrasound policies also varied widely within and between professions.

Routine ultrasound estimation of gestational age was reported by 72 specialist obstetricians (68%) and 92 midwives (33%) (p<0.001). A fetal anomaly scan at about 18–20 weeks’ gestation was routinely offered by 31 specialist obstetricians (30%) and 44 midwives (16%) (p<0.01). Ultrasound to detect fetal growth restriction in all pregnant women was reportedly used by 29 obstetricians (28%) and 11 midwives (4%) (p<0.001).

Overall, midwives were more optimistic than obstetricians about the impact of antenatal care on pregnancy outcome. The authors concluded that although the standard antenatal care package provided by the two professions in The Netherlands appeared relatively uniform, there were wide variations within and between professions in whether tests were recommended for some or all pregnant women, how normal and abnormal findings were defined, and the potential implications of abnormal findings.