title: The development and application of a new tool to assess the adequacy of the content and timing of antenatal care.
abstract: BACKGROUND
  Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care.
  
  
  METHODS
  The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from 'Inadequate' (both tools) to 'Adequate plus' (APNCU) or 'Appropriate' (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools.
  
  
  RESULTS
  According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as 'Adequate' or 'Adequate plus' by the APNCU were deemed 'Inadequate' by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care.
  
  
  CONCLUSIONS
  The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as 'Inappropriate'. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure.
authors: Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Laarbeeklaan 103, 1090 Brussels, Belgium. katrien.beeckman@vub.ac.be
authors: Katrien
authors: K
authors: Beeckman
authors: Fred
authors: F
authors: Louckx
authors: Godelieve
authors: G
authors: Masuy-Stroobant
authors: Soo
authors: S
authors: Downe
authors: Koen
authors: K
authors: Putman
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium; D005260:Female; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D008429:Maternal Welfare; D008991:Monitoring, Physiologic / Q000379:methods; D017060:Patient Satisfaction; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards* / Q000639:trends; D013997:Time Factors; D055815:Young Adult