Antenatal care and risk assessment in a working primary health care clinic: a critical look

ABSTRACT

Vistis to antenatal clinics are meant to detect, prevent or manage abnormalities in early pregnancy and prepare mothers for safe deliveries. Risk assessment, using risk scores, is one of the tools used for this purpose. This study describes the working procedure and the services delivered in a working clinic in Jeddah, Saudi Arabia, analyses antenatal visits and describes various aspects of the process of risk assessment. A total of 280 mothers made 1,007 clinic visits in 1991, a mean of 3.6 visits per mother. Attendance for the first visit was relatively late in pregnancy. One-third of all mothers were seen only once or twice in this clinic. Two-thirds of the expected delivery dates were mistaken by a difference of up to 4 weeks. The service lacked many important functions such as nutritional advice and proper health education. Feedback from the hospital was insufficient to judge the effect of risk assessment. Scores used for various pregnancy conditions were criticized for their subjective risk weight with regard to the Arabic pattern of pregnancy and delivery. It is recommended that antenatal care should be restructured according to the available resources of health centres in the community. Clear working protocols for these clinics, a two-way referral system, better training of the service provider and a review of risk scores are some of the recommendations: