Specialised antenatal clinics for women with a multiple pregnancy for improving maternal and infant outcomes.
BACKGROUND
Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no consensus as to what constitutes optimal care. 'Specialised' antenatal clinics have been advocated as a way of improving outcomes for women and their infants.


OBJECTIVE
To assess, using the best available evidence, the benefits and harms of 'specialised' antenatal clinics compared with 'standard' antenatal care for women with a multiple pregnancy.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 April 2012).


METHODS
All published, unpublished, and ongoing randomised controlled trials with reported data that compared outcomes in mothers and babies with a multiple pregnancy who received antenatal care specifically designed for women with a multiple pregnancy (as defined by the trial authors) with outcomes in controls who received 'standard' antenatal care (as defined by the trial authors).


METHODS
Both review authors independently assessed trials for inclusion and trial quality. Both review authors extracted data. Data were checked for accuracy.


RESULTS
There were data available from one study included in the review involving 162 women with a multiple pregnancy. For the only reported primary outcome, perinatal mortality, there were no statistically significant differences identified between specialised antenatal care and standard care (risk ratio (RR) 1.02; 95% confidence interval (CI) 0.26 to 4.03). Women receiving specialised antenatal care were significantly more likely to birth by caesarean section (RR 1.38; 95% CI 1.06 to 1.81). Data was not reported in the study on the following primary outcomes: small-for-gestational age, very preterm birth or maternal death. There were no statistically significant differences identified between specialised antenatal care and standard care for other secondary outcomes examined: postnatal depression (RR 0.48; 95% CI 0.19 to 1.20), breastfeeding (RR 0.63; 95% CI 0.24 to 1.68), still birth (RR 0.68; 0.12 to 4.04) or neonatal death (RR 2.05; 95% CI 0.19 to 22.39).


CONCLUSIONS
There is currently limited information available from randomised controlled trials to assess the role of 'specialised' antenatal clinics for women with a multiple pregnancy compared with 'standard' antenatal care in improving maternal and infant health outcomes. The value of 'specialised' multiple pregnancy clinics in improving health outcomes for women and their infants requires evaluation in appropriately powered and designed randomised controlled trials.
School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide,Australia. jodie.dodd@adelaide.edu.au.
Jodie M
JM
Dodd
Caroline A
CA
Crowther
D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D008429:Maternal Welfare; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D059285:Pregnancy, Twin; D011295:Prenatal Care / Q000379:methods / Q000592:standards*; D016032:Randomized Controlled Trials as Topic