The quality of antenatal care in Turkey and the role of ultrasonography in the antenatal care system

OBJECTIVE: The aim of this study was to determine the quality of antenatal care and the role of routine obstetric ultrasonography (US) in Turkey's antenatal care program. MATERIALS AND METHOD: Two surveys consisting of 11 questions were conducted on 295 patients without pregnancy associated risk in 1995 and on 208 patients in 2000, during the first 24 h after delivery. The results of the two surveys were compared. A P value of <0.05 was used to denote statistical significance. RESULTS: When the results of the two surveys were compared, we found that in 2000, patients had started their antenatal visits earlier in pregnancy than those in 1995 and basic laboratory tests, such as complete blood count, urinalysis, and diabetes screening had been performed on an increased number of patients receiving antenatal care outside our clinic. Ultrasonographic examination was performed on all of the patients during their antenatal visits in 2000, while only 76.6% of the cases were examined by US in 1995. The number of ultrasound examinations per antenatal visit had significantly increased (0.47 in 1995 versus 0.6 in 2000, [Odds ratio: 1.277, 95% confidence interval: 1.12-1.44]). Data from 2000 has shown that 8.7% (5/57) of the patients who received antenatal care outside our clinic (Group 1) had been examined using US at least 10 times. However, 17.5% of these patients had not undergone a complete blood count (CBC) or urinalysis and blood pressure had not been measured at all in 5.2% of cases. CONCLUSION: Despite some differences, we believe that the situation in Turkey is similar to that in the rest of the world. The expectations women have of ultrasound examination are much higher than can be realised in reality. In Turkey, it appears that many physicians, especially those based in large cities, rely on highly technical procedures like ultrasonography and neglect the basics of antenatal care (blood pressure measurements, complete blood counts, urinalysis, diabetes screening etc.).