PREPREGNANCY COUNSELING - EXPERIENCE FROM 1075 CASES

Objective To assess the activity of a prepregnancy counselling clinic in terms of investigations, counselling, treatment and subsequent pregnancy outcome. Design Review of 1 075 couples attending over a nine year period. Setting University Hospital offering a tertiary referral service for fetal medicine. Subjects Couples referred to the clinic from a variety of sources. Main outcome measures Categories of referral, value of diagnostic tests, and subsequent pregnancy outcome. Results The main categories of referral were: previous miscarriage (44.4%); previous fetal abnormality (19.6%); chronic maternal disease (22.3%); and others (13.7%). Routine investigations produced a low yield of abnormality (1%), in contrast to investigations selected for specific reasons (12%). Subsequent pregnancy outcome, which was unaltered in either the previous miscarriage or fetal abnormality groups, did improve in the chronic maternal disease group. Conclusions This study does not prove the value of prepregnancy counselling. However, it does illustrate the importance of making an accurate assessment of previous problems and current health as a means of determining both maternal and fetal risks in a subsequent pregnancy, a process which seems to lead to an improved outcome within selected groups. The importance of continuity of care in all couples, especially when there has been a previous adverse pregnancy outcome is emphasized.