Prenatal health care beyond the obstetrics service: utilization and predictors of unscheduled care.
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.


METHODS
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.


CONCLUSIONS
Unscheduled care is common during pregnancy.
Magriples
Urania
U
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520-8034, USA. urania.magriples@yale.edu
Kershaw
Trace S
TS
Rising
Sharon Schindler
SS
Massey
Zohar
Z
Ickovics
Jeannette R
JR
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D005260:Female; D005865:Gestational Age; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009774:Obstetrics / Q000458:organization & administration / Q000706:statistics & numerical data; D009819:Office Visits / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011336:Probability; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012959:Socioeconomic Factors