title: A descriptive study of women presenting to an obstetric triage unit with no prenatal care.
abstract: OBJECTIVE
  To describe women presenting to an obstetric triage unit with no prenatal care (PNC), to identify gaps in care, and to compare care provided to World Health Organization (WHO) standards.
  
  
  METHODS
  We reviewed the charts of women who gave birth at Women's Hospital in Winnipeg and were discharged between April 1, 2008, and March 31, 2011, and identified those whose charts were coded with ICD-10 code Z35.3 (inadequate PNC) or who had fewer than 2 PNC visits. Three hundred eighty-two charts were identified, and sociodemographic characteristics, PNC history, investigations, and pregnancy outcomes were recorded. The care provided was compared with WHO guidelines.
  
  
  RESULTS
  One hundred nine women presented to the obstetric triage unit with no PNC; 96 (88.1%) were in the third trimester. Only 39 women (35.8%) received subsequent PNC, with care falling short of WHO standards. Gaps in PNC included missing time-sensitive screening tests, mid-stream urine culture, and Chlamydia and gonorrhea testing. The mean maternal age was 26.1 years, and 93 women (85.3%) were multigravidas. More than one half of the women (51.4%) were involved with Child and Family Services, 64.2% smoked, 33.0% drank alcohol, and 32.1% used illicit drugs during pregnancy. Two thirds of the women (66.2%) lived in inner-city Winnipeg. Only 63.0% of neonates showed growth appropriate for gestational age. Two pregnancies ended in stillbirth; there was one neonatal death, and over one third of the births were preterm.
  
  
  CONCLUSIONS
  Most women who present with no PNC do so late in pregnancy, proceed to deliver with little or no additional PNC, and have high rates of adverse outcomes. Thus, efforts to improve PNC must focus on facilitating earlier entry into care. This would also improve compliance with WHO guidelines for continuing care. Treatment protocols could improve gaps in obtaining urine culture and in Chlamydia and gonorrhea testing.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of British Columbia, Vancouver BC.
authors.forename: Erin
authors.initials: E
authors.lastname: Knight
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Manitoba, Winnipeg MB.
authors.forename: Margaret
authors.initials: M
authors.lastname: Morris
authors.affiliation: Faculty of Nursing, University of Manitoba, Winnipeg MB.
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008350:Manitoba; D009775:Obstetrics and Gynecology Department, Hospital; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology; D014218:Triage
keywords: high-risk pregnancy; pregnancy; pregnancy outcome; prenatal care; retrospective study