Preconceptionele advisering: evaluatie van een polikliniek in een academisch ziekenhuis

To provide an overview of the outcomes from an outpatients' clinic for preconceptional counselling in the Netherlands and to assess its activities in terms of referrals, referral indications, supplementary investigations, treatment policy and a possible future pregnancy.

Design

Retrospective, descriptive.

Method

Data were collected from the medical records of women who were seen at the outpatients’ clinic for preconceptional counselling, University Medical Centre St Radboud, Nijmegen, the Netherlands, during the period 1 January 1996-6 July 2000.

Results

Of the 484 women studied, medical records were available for 459 (95); their median age was 31 years (range: 19-44). Most of the women with one or more risk factors were referred by gynaecologists (65), followed by general practitioners (17) and other specialists (14). The main categories of referral were previous complicated obstetric history, previous fetal abnormality, and chronic maternal disease. Half of the women were subjected to supplementary investigations on the basis of an indication; hyperhomocysteinaemia was diagnosed in 24, other form of thrombophilia (coagulopathy) in 21 and vitamin deficiency in 18. The most frequent preconceptional interventions were the correction of hyperhomocysteinaemia by means of administering folic acid or other vitamin supplements and a change of therapy or cessation of therapy for potentially teratogenic medications.

Conclusion

The outpatients' clinic for preconceptional counselling helped to minimise risk factors for adverse pregnancy outcome amongst high-risk women by providing extensive advice as well as by means of the early detection and treatment of diagnosed abnormalities.